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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418310
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:13:13 PM

Document Has Been Signed on 12/10/2024 01:13 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:FULLBRIGHT ES.CSPPFACILITY NUMBER:
197418310
ADMINISTRATOR/
DIRECTOR:		RUIZ, CLAUDIAFACILITY TYPE:
850
ADDRESS:6940 FULLBRIGHT AVENUE RM. 2TELEPHONE:
(818) 340-6677
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 12DATE:
12/10/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Michael Payne, Principal TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection on 12/10/2024 for the purpose of addressing an Action Lead Exceedance (ALE) at the facility. LPA arrived to the facility at 11:40AM and met with Michael Payne, Principal. Principal advised LPA to singularly tour of the facility. LPA was notified that care is being provided in Room 4 and Irina Manukyan, Head Teacher, will be able to conducted the inspection with LPA. Upon arriving to Room 4, LPA observed 12 children and 1 staff present.

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 10/18/2022. The sample testing was for Outlet "A" with results above 5.5 ppb which is considered an exceedance. Outlet "A" was reported to have an exceedance of 363ppb. LPA was not able to verify which outlets were tested because a facility sketch was not provided to the Department prior or during the inspection.

LPA advised Principal that the following documents pending are as followed:
Completed External Water Sampler Self-Certification Form (LIC 9275)
Completed Child Care Center Sampling Checklist Form (LIC 9276)
Facility Sketch identifying the location of water outlet/s used for drinking
A copy of the initial water testing results for outlets tested
Proof of corrections for Outlet "A"
A copy of water retesting results summary for Outlets "A"

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: FULLBRIGHT ES.CSPP
FACILITY NUMBER: 197418310
VISIT DATE: 12/10/2024
NARRATIVE
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Principal was advised to posted lead 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 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 “A”.

Based on interviews and results reported to the Department, it has been determined that CALVERT ELEMENTARY SCHOOL STATE PRESCHOOL 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 Michael Payne, Principal.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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Document Has Been Signed on 12/10/2024 01:13 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 12/10/2024 at 12:37 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: FULLBRIGHT ES.CSPP
FACILITY NUMBER: 197418310

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
100700.3(b)(1)

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater...(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidence by:
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Per Principal, the following documents will be submitted to LPA via email by POC due date: Completed External Water Sampler Self-Certification Form (LIC 9275), Completed Child Care Center Sampling Checklist Form (LIC 9276),Facility Sketch identifying the location of water outlet/s used for drinking,
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Based on results submitted to the Department, the facility did not comply with the section cited above in Outlet "A" was reported to have an exceedance of 363 ppb, exceeding allowable limit for lead, which poses a potential Health, Safety or Personal Rights risk to persons in care.
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a copy of the initial water testing results for outlets tested, Proof of corrections for Outlet "A" and, a copy of water retesting results summary for Outlets "A".

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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: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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