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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202152
Report Date: 10/03/2022
Date Signed: 10/03/2022 01:17:54 PM

Document Has Been Signed on 10/03/2022 01:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VALLEY BETH SHALOM NURSERY SCHOOLFACILITY NUMBER:
191202152
ADMINISTRATOR:ABBY MARSFACILITY TYPE:
850
ADDRESS:15739 VENTURA BOULEVARDTELEPHONE:
(818) 788-0567
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY: 249TOTAL ENROLLED CHILDREN: 249CENSUS: 140DATE:
10/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Renee KalmansonTIME COMPLETED:
01:35 PM
NARRATIVE
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On 10/03/2022 at 9:48 AM, Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Renee Anzaruth- Kalmanson (Assistant Director) and toured the facility. During today’s visit there are 140 children and 27 teachers.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1,2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 7/18/2022. The sample test for the meat kitchen faucet labeled RR, Dairy kitchen faucet labeled XX, and Maylm Room labeled DD identified on the facility sketch, tested over 5.5 ppb/ug, which exceeds allowable limit for lead.

During today’s visit LPA observed the water fountains identified on facility sketch are currently inoperable. The faucet labeled DD is in a classroom that is not a part of the childcare facility has been replaced and currently not in use pending retesting.. The faucet labeled XX is shut off and labeled not in use.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VALLEY BETH SHALOM NURSERY SCHOOL
FACILITY NUMBER: 191202152
VISIT DATE: 10/03/2022
NARRATIVE
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Facility representative stated XX was being used for mop water purposes only, usage has ceased since testing results have been reported. The water faucet labeled RR has been shut off, not in use and was not being used prior to testing.

Licensee will post testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility. Facility representative will email parents with lead testing results and information of remediation.

During today’s visit LPA took pictures of the water faucets DD, RR and XX . LPA issued a Type B violation under 101704 Lead Action Level Exceedance Response Requirements

(a) If a drinking water outlet test results in an Action Level Exceedance, the use of that outlet for drinking and food preparation purposes shall immediately cease until it is replaced and retested pursuant to section 101705 and returns a result at or below the Action Level.

LPA provided the facility representative with a copy of Provider Information Notice (PIN) 21-21CCP and Lead Testing in Child Care Centers Frequently Asked Questions.

A copy of this Report (LIC809 & LIC809D), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to the Renee Kalmanson

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VALLEY BETH SHALOM NURSERY SCHOOL
FACILITY NUMBER: 191202152
VISIT DATE: 10/03/2022
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/03/2022 01:17 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 10/03/2022 at 12:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: VALLEY BETH SHALOM NURSERY SCHOOL
FACILITY NUMBER: 191202152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2022
Section Cited
CCR
101704(a)

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101704 Lead Action Level Exceedance Response Requirements (a) If a drinking water outlet test results in an Action Level Exceedance, the use of that outlet.. shall immediately cease until it is replaced and retested ... returns a result at or below the Action Level. This requirement not met as evidence by:
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Faciilty has replaced water outlet DD and ceased usage pending retesting. Water outlet DD will not be accessible for use until a retest has been conducted. Water outlets RR and XX have been shut off and the facility has permanently cease use of the water outlets
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Based on observation, interviews, and review of Lead water testing samples, it is revealed that levels of lead were beyond the allowable amount deemed by the State of California. water Outlets “DD, “RR”, , and “XX” have Action Lead Exceedance (ALE) level of , 23, 6.9, and 6.4 pbb. This poses a potential health and safety risk to children in care.
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The facility represenative emailed copies of the test results to all parents/guardians who children are under care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022


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