UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 05/03/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG. to conduct an unannounced case management visit. LPA Ornelas was met by Assistant Director - Courtney Kumar and Maria Patrice Wynn- Director (who arrived after the facility tour). LPA informed Assistant Director about the purpose of the visit and was guided on a tour of the facility. LPA observed 18 children and 9 adults during today’s visit. The facility has been identified to have a water outlet with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 ppb, or greater. The purpose of today’s visit is to ensure that faucets are not in use and there is potable source of water for children and staff at the facility. Per retest information provided by Licensing Program Manager (LPM) that was conducted on 2/14/2023, the following water outlet yielded the following results: 1) Faucet C- 6.0 ppb Per Director and documentation, Faucet C ( located in the Gold Room Yard) did not test for lead exceedance on 10/31/2022, which was the first time samples were collected. Therefore, it was not retested on 2/14/2023. During the facility visit on 4/10/2023, there was a misunderstanding. It has now been clarified that Faucet G - Outdoor Blue Yard - Spigot Next to Blue Room entrance): 6.0 ppb During today’s visit LPA Ornelas conducted a tour of the facility and observed 1 water outlet spigot (Faucet G) that has been made inaccessible. Not used for food prep or consumption. LPA obtained photo of the water outlet that was identified on the facility sketch. Director stated that the children do not consume water from the water outlet. Per assistant director, purified Brita filtered drinking water is provided and accessible to children in care. LPA observed Brita filtered water in the classrooms. SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023 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 2 FACILITY NAME: UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.FACILITY NUMBER: 197410448 VISIT DATE: 05/03/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Based on observation, interviews and supportive documents it has been determined that UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG 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. Lead water testing sample re taken on 02/14/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California for Faucet G. At this time, LPA did not observe and was unable to obtain test results that show Faucet C tested for Lead Exceedance. LPA obtained: External Water Sample Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), and Facility Sketch (fully labeled with locations of all water outlets), Final Results Report for 10/31/2022 and 02/28/2023. LPA discussed Proof of Correction (POC). Director stated Faucet G will be capped off and be taken out of use on or before 6/3/2023. LPA will be notified via email at suzette.ornelas@dss.ca.gov 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. Please see Provider Information Notice (PIN) 20-01-CCP for more information about lead toxicity prevention. Exit interview conducted. A copy of this report, and Notice of Site Visit provided to Director. SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 05/03/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG. to conduct an unannounced case management visit. LPA Ornelas was met by Assistant Director - Courtney Kumar and Maria Patrice Wynn- Director (who arrived after the facility tour). LPA informed Assistant Director about the purpose of the visit and was guided on a tour of the facility. LPA observed 18 children and 9 adults during today’s visit. The facility has been identified to have a water outlet with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 ppb, or greater. The purpose of today’s visit is to ensure that faucets are not in use and there is potable source of water for children and staff at the facility. Per retest information provided by Licensing Program Manager (LPM) that was conducted on 2/14/2023, the following water outlet yielded the following results: 1) Faucet C- 6.0 ppb Per Director and documentation, Faucet C ( located in the Gold Room Yard) did not test for lead exceedance on 10/31/2022, which was the first time samples were collected. Therefore, it was not retested on 2/14/2023. During the facility visit on 4/10/2023, there was a misunderstanding. It has now been clarified that Faucet G - Outdoor Blue Yard - Spigot Next to Blue Room entrance): 6.0 ppb During today’s visit LPA Ornelas conducted a tour of the facility and observed 1 water outlet spigot (Faucet G) that has been made inaccessible. Not used for food prep or consumption. LPA obtained photo of the water outlet that was identified on the facility sketch. Director stated that the children do not consume water from the water outlet. Per assistant director, purified Brita filtered drinking water is provided and accessible to children in care. LPA observed Brita filtered water in the classrooms. SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023 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 2 FACILITY NAME: UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.FACILITY NUMBER: 197410448 VISIT DATE: 05/03/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Based on observation, interviews and supportive documents it has been determined that UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG 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. Lead water testing sample re taken on 02/14/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California for Faucet G. At this time, LPA did not observe and was unable to obtain test results that show Faucet C tested for Lead Exceedance. LPA obtained: External Water Sample Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), and Facility Sketch (fully labeled with locations of all water outlets), Final Results Report for 10/31/2022 and 02/28/2023. LPA discussed Proof of Correction (POC). Director stated Faucet G will be capped off and be taken out of use on or before 6/3/2023. LPA will be notified via email at suzette.ornelas@dss.ca.gov 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. Please see Provider Information Notice (PIN) 20-01-CCP for more information about lead toxicity prevention. Exit interview conducted. A copy of this report, and Notice of Site Visit provided to Director. SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023