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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870893
Report Date: 03/27/2024
Date Signed: 03/27/2024 01:12:18 PM

Document Has Been Signed on 03/27/2024 01:12 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:NINETY FIFTH STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191870893
ADMINISTRATOR:CHILDRESS, CANDIEFACILITY TYPE:
850
ADDRESS:1027 W 96TH STREETTELEPHONE:
(323) 777-0920
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 116TOTAL ENROLLED CHILDREN: 116CENSUS: 32DATE:
03/27/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amy Allina - Chambers, Principal TIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection on 03/27/2024 for the purpose of addressing an Action Lead Exceedance (ALE) at the facility. LPA arrived to the facility at 11:00 AM and met with Amy Allina - Chambers, Principal, who guided analyst on a tour of the facility. LPA observed 32 children with 14 staff upon arrival.

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 10/18/2023. The sample test for the water fountain located outside Room 3, identified on the facility sketch by letter “E”, tested at 10.3 bbp exceed allowable limit for lead. Test samples testing over 5.5 ppb and above is considered an exceedance.

During today’s visit LPA was provided with retesting results of the Lead Water Testing conducted at the facility on 1/31/2023. Principal provided LPA with a copy of the Plan of Corrections for water outlet "E". The Principal is reporting that point -of use filters have been installed as a plan of correction. Principal disclosed that a maintenance service log for the water filters are kept at the facility.

LPA took pictures of the water outlets “E". 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.

Principal has posted lead testing results, in a location (facility lobby) consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, --Page 1 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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: NINETY FIFTH STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870893
VISIT DATE: 03/27/2024
NARRATIVE
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for parents and families to view at the facility within 24-hours of receiving the results from the Department. Facility will notify 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 “E".

Based on interviews and supportive documents, it has been determined that Ninety Fifth Street Early Education Center violated Child Care Licensing Regulation Division 12, Chapter 1, 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. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. Refer to LIC 809-D for deficiency page.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Amy Allina - Chambers, Principal.

---Page 2 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/27/2024 01:12 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 03/27/2024 at 12:45 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: NINETY FIFTH STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2024
Section Cited
CCR
101700.3(b)(1)

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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Per Principal, plan of correction was to replace the bubbler and existing point of use filters.
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This requirement was not met as evidence by: Based on interviews and supportive documents, the facility did not comply with the section cited above in the water fountain located outside Room 3, identified on the facility sketch by letter “E”, tested at 10.3 bbp on 10/18/2022 exceeding allowable limit for lead which poses a potential Health, Safety or 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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


LIC809 (FAS) - (06/04)
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