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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419097
Report Date: 09/29/2025
Date Signed: 09/29/2025 01:03:03 PM

Document Has Been Signed on 09/29/2025 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PETITE SCHOOL HOUSEFACILITY NUMBER:
197419097
ADMINISTRATOR/
DIRECTOR:		SALMEENA ZAKIFACILITY TYPE:
850
ADDRESS:17643 ROSCOE BLVD.TELEPHONE:
(818) 708-8766
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 182TOTAL ENROLLED CHILDREN: 101CENSUS: 87DATE:
09/29/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:SALMEENA ZAKITIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 9/29/2025, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced case management inspection for the purpose of addressing an Action Lead Exceedance (ALE) at the facility. LPA met with Director, SALMEENA ZAKI who guided LPA on a tour of the facility. LPA observed 87 children and 11 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 09/17/2025. The sample testing was for Outlet "H, C, D, G" with results above 5.5 ppb which is considered an exceedance. Outlet "H" was reported to have an exceedance of 13.0ppb. Outlet "H" was observed located inside Degas classroom. Outlet "C" was reported to have an exceedance of 12.0ppb. Outlet "C" was observed outdoors to the right of the Matisse classroom. Outlet "D" was reported to have an exceedance of 6.9ppb. Outlet "D" was observed outdoors located to the left of the Matisse room. Outlet "G" was reported to have an exceedance of 6.8ppb. Outlet "G" was observed located inside DaVincci classroom.

Director was notified that lead testing results should be posted, 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 Outlets “H, C, D, G”.
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Suzette Ornelas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097
VISIT DATE: 09/29/2025
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Based on interviews and results reported to the Department, it has been determined that 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.

Per Director, all 4 outlets that were reported to have a lead exceedance have been shut off completely as of 8/19/2025, which is the date the results were obtained. Currently, water is being provided to children in pitchers using water obtained from the kitchen sink, which did not test for lead exceedance. LPA conducted a walk through of the facility and observed all 4 outlets which tested for a lead exceedance to have been shut off. LPA observed pitchers of water located inside of the classrooms along with a refillable water container belonging to each individual child. Deficiency has been cleared as of today.

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

Exit interview conducted and a copy of the report was provided to Director, SALMEENA ZAKI.
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Suzette Ornelas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/29/2025 01:03 PM - It Cannot Be Edited


Created By: Suzette Ornelas On 09/29/2025 at 12:19 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: PETITE SCHOOL HOUSE
FACILITY NUMBER: 197419097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2025
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 Director, 4 faucets have been shut off complately and school will provide water from a non contaminated fixture located in the kithen/ LPA observed pitchers located in each classroom along with a refillable water container for each child in care.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 4 faucets at the facility tested with a lead exceedance with values of 5.5 ppb or greater 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.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Suzette Ornelas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2025


LIC809 (FAS) - (06/04)
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