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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602063
Report Date: 12/05/2022
Date Signed: 12/05/2022 01:03:08 PM

Document Has Been Signed on 12/05/2022 01:03 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MANHATTAN BEACH NURSERY SCHOOL, INCFACILITY NUMBER:
191602063
ADMINISTRATOR:CAROL TATSUMIFACILITY TYPE:
850
ADDRESS:1520 NELSON AVETELEPHONE:
(310) 376-1910
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 5DATE:
12/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Carol TatsumiTIME COMPLETED:
01:15 PM
NARRATIVE
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On 12/5/2022, Licensing Program Analyst (LPA) Loyce Phillips, conducted an unannounced case management - deficiencies visit. LPA was met by Director, Carol Tatsumi. LPA toured the facility and observed 5 children in care.

LPA explained the purpose of the visit. The department has received testing results, indicating 1 water outlet have been identified with an Action Level Exceedance (ALE) in the amount of lead in water being 5.5 ppb, or greater.

During today’s inspection, LPA obtained the following documents: Child Care Center Sampling Checklist Form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275) and Facility Sketch labeled with locations of all water outlets that were tested.

LPA observed 1 water outlet that has ALE. Outlet B was identified and is located in the backyard on the deck. Director, informed LPA the outlet tested, is not used for food preparation or drinking. The outlet have been inoperable for 6 months. The outlet was labeled with a sign that states " Do Not Drink, water out of use". LPA took photos and verified that the outlet was identified on the facility sketch. LPA ensured the water outlet was not in use and there is a potable source of water for children and staff. Drinking water is available indoors and water that has been filtered and placed in a pitcher is located outdoors. LPA observed Lead Testing results posted on Parent Board.

Lead water testing samples collected on 10/13/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. Per the Written Directives for Lead Testing of Water in Licensed Child Care Center, AB 2370 the following deficiency is cited (See next page 809-D).

809-C

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MANHATTAN BEACH NURSERY SCHOOL, INC
FACILITY NUMBER: 191602063
VISIT DATE: 12/05/2022
NARRATIVE
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 Instructions for required lead testing are outlined in PIN 21-21. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations Care Child Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in a parts per billion (ppb) unit of measurement.

For more information, go to the California Childhood. Lead Poisoning Prevention Branch's website at www.cdph.ca.gov/programs/clppb Please see Provider Information Notice (PIN) 20-01-CCP for more information about lead toxicity prevention

An Exit interview conducted and appeal right explained. A copy of this report, appeal rights, and Notice of Site Visit provided to Director, Carol Tatsumi.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/05/2022 01:03 PM - It Cannot Be Edited


Created By: Loyce Phillips On 12/05/2022 at 12:05 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: MANHATTAN BEACH NURSERY SCHOOL, INC
FACILITY NUMBER: 191602063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2022
Section Cited

101700.3(b)(1)

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101700.3(b)(1) California Lead Action at Child Care Centers (b)Testing results with fractional ppb readings....(1) A result of 5.5ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by the Action Level Exceedance results revealed
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Facility has completed shut off water source and wil pemenanetly cap off water source for outlet identified with an Action Lead Exceedance of 5.5 ppb or over. These outlets will not be accessible for use until remediation occurred. Director will send LPA a copy of the plan of correction on or before 12/9/2022.
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that levels of lead were beyond allowable amount deemed by the State of California, if not corrected this poses a potential Health and Safety or Personal Rights risk to children 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:Peter Flores
LICENSING EVALUATOR NAME:Loyce Phillips
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022


LIC809 (FAS) - (06/04)
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