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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224698
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:21:32 PM

Document Has Been Signed on 04/13/2023 02:21 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:FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTENFACILITY NUMBER:
191224698
ADMINISTRATOR:STEPHANIA RASMUSSENFACILITY TYPE:
850
ADDRESS:7644 FARRALONE AVE.TELEPHONE:
(818) 340-6131
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 180TOTAL ENROLLED CHILDREN: 168CENSUS: 158DATE:
04/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Elizabeth Orozco, Director TIME COMPLETED:
09:59 AM
NARRATIVE
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On 04/13/2023 at 8:47 AM, Antonio Almanza, Licensing Program Analyst (LPA) conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE) facility inspection. LPA met with Elizabeth Orozco, Director and toured the facility. During today’s visit there are 158 children and 20 teachers.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 02/18/2023. The sample test for the water fountain located in Room 21, identified on the facility sketch by letter “A”, tested at 11.4 bbp; water fountain located in Room 22, identified on the facility sketch by letter “B”, tested at 23.3 bbp; and water fountain located in Room 23, identified on the facility sketch by letter “C”, tested at 9.93 bbp. Test samples testing over 5.5 ppb and above is considered an exceedance.

During today’s visit LPA observed that water outlets (A), (B), and (C) have been removed. The Director is reporting they provide water bottles for children in care since Covid-19 started.

Facility will post lead testing results, in a location (facility office) 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 within 24-hours of receiving the results from the Department. Facility has notified all parents or guardians of children in care of lead exceedance results and what has been done to date and remediation plan for water outlet “A”, “B” and “C”.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698
VISIT DATE: 04/13/2023
NARRATIVE
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During today’s visit LPA took pictures of the water outlets “A”, “B” and “C”. LPA received copies of External Water Sampler Self-Certification Form (LIC 9275); Child Care Center Sampling Checklist Form (LIC 9276); Facility Sketch (LIC 999) in which all water outlets are noted; and a copy of water testing results summary.

During today’s visit one Type B violation is being issued per PIN 21-21.1-CCP, Title 22 Regulations, Division 12, and Subchapter 5: 101700.3(b)(1) California Lead Action Level at Child Care Centers: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

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.

For more information, go to the California Childhood. Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb or call them at (510) 620-5600. LPA emailed and provided the Director with the Provider Information Notice (PIN) 21-21CCP and Lead Testing in Child Care Centers Frequently Asked Questions.

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.

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

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/13/2023 02:21 PM - It Cannot Be Edited


Created By: Antonio Almanza On 04/13/2023 at 09:13 AM
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: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This Requirement is not met as evidenced by:
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The facility has removed water outlets A, B, and C. The facility has been providing warer bottles for children in care since June 2020.
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Based on observation, interview and record review, The facility has three water outlets (A), (B), and (C) that tested in lead exceedance, which poses an immediate or Health and Safety, and personal rights risk to persons in 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:Betty Bell
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
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