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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494827
Report Date: 09/15/2022
Date Signed: 09/15/2022 01:15:46 PM

Document Has Been Signed on 09/15/2022 01:15 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:ACHIEVERS ACADEMY PRESCHOOLFACILITY NUMBER:
197494827
ADMINISTRATOR:MARIA GOLDMANFACILITY TYPE:
850
ADDRESS:9025 LANGDON AVENUETELEPHONE:
(818) 830-8123
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 132TOTAL ENROLLED CHILDREN: 62CENSUS: 51DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH: Director Priscilla RiveraTIME COMPLETED:
01:30 PM
NARRATIVE
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On 9/15/2022 at 11:11 AM, Licensing Program Analyst (LPA) Antonio Almanza conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with the Director Priscilla Rivera and toured the facility. During today’s visit there are 51 children and 7 teachers.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 8/18/2022. The sample test for the water fountain located in front of room 7 identified on the facility sketch by letter “B”, tested at 5.9 bbp/ug L, which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

During today’s visit LPA observed water fountain identified on facility sketch. LPA observed the water fountain inoperable; covered with plastic making it inaccessible to children in care. The water fountain has also been shut off.

During today’s visit LPA took pictures of the water fountain (B). LPA received an email from the facility with copies of Facility Sketch (water faucets/outlets identified) and copy of water testing results summary.

Per director children have access to water fountain "E" located approximately 18 steps away from the water fountain “B”, in front of room 8.

During today’s visit one Type B violation is being issued under Title 22 Regulations, Division 12, and Chapter1: Physical Plant, Building and Grounds - Section 101238(a) The Child Care Center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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: ACHIEVERS ACADEMY PRESCHOOL
FACILITY NUMBER: 197494827
VISIT DATE: 09/15/2022
NARRATIVE
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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 provided the director with, Provider Information Notice (PIN) 21-21CCP.

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 (LIC9099 & LIC9099d), Appeal Rights (LIC9058) and Notice of Site Visit were reviewed and provided to the Director Priscilla Rivera.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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Document Has Been Signed on 09/15/2022 01:15 PM - It Cannot Be Edited


Created By: Antonio Almanza On 09/15/2022 at 12:47 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: ACHIEVERS ACADEMY PRESCHOOL
FACILITY NUMBER: 197494827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a) The Child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well being of children , employee and visitors.
This requirement not met as evidence by:
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Director has made water fountain inaccessible and water is available to children. Water pitchers are available for supplying children with water in doors and outdoors.
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Based ointerview and record review, results of the Lead Water Testing conducted at the facility on 8/18/2022 were in exceedance, which poses a potential Health or Safety, or personal rights risk to persons in care.
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Director will speak with the owner to determine if water fountain will be replaced or removed. Director will provide answer by 09/19/22 and final corrections will completed by 09/30/22.

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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:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022


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