UCLA INTERV PROG DEV HANDICAPPED INF & CHILD

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 02/16/2023 at 8:35 AM, Denise Miranda, Licensing Program Analyst (LPA), conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Dane Fitzmorris, Director, and toured the facility. Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 01/26/2023. The sample test for the sink, located in Room 24-13 a cubby room, identified on the facility sketch by letter “C”, tested at 6.4 ppbp/ug L, and sample test for the sink, located in Room 23-31 exercising room, identified on the facility sketch by Letter “F”, tested at 6.9 ppb/ L. which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance. LPA observed the the area of sink located in room 24-13, that was removed and in Room 23-31 facility removed the faucet and placed a signed “do not use this sink”. The Director is reporting that the classroom 23-31 is in use only for children exercising. Facility will provide water it children from the kitchen water filtration system and from room 24-13 cubby room, facility removed the sink and the sink will be replace no later than tomorrow. Licensee has posted testing results, in a location (cub room and observation room) 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 has notified 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 “C and "F". SUPERVISORS NAME: Rita Ramos LICENSING EVALUATOR NAME: Denise Miranda LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023 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 3 FACILITY NAME: UCLA INTERV PROG DEV HANDICAPPED INF & CHILDFACILITY NUMBER: 191600834 VISIT DATE: 02/16/2023 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 32During today’s visit LPA took pictures of the location of the water faucet (C) and (F). LPA received via email 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 copy of water testing results summary. . During today’s visit one Type B violation is being issued per PIN 21-21-CCP, Title 22 Regulations, Division 12, and 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. 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 will email and provide the Director with the Provider Information Notice (PIN) 21-21CCP and Lead Testing in Child Care Centers Frequently Asked Questions. The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring 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 (LIC809 & LIC809D), Appeal Rights (LIC9058), and Notice of Site Visit (LIC9213) were reviewed and provided to Dane Fritzmorris, Director. SUPERVISORS NAME: Rita Ramos LICENSING EVALUATOR NAME: Denise Miranda LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023 FACILITY NAME: UCLA INTERV PROG DEV HANDICAPPED INF & CHILD FACILITY NUMBER: 191600834 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/16/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/02/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(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 Requirement is not met as evidenced by: Based on observation, interview 1 2 3 4 5 6 7The facility will have the sink

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 02/16/2023 at 8:35 AM, Denise Miranda, Licensing Program Analyst (LPA), conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Dane Fitzmorris, Director, and toured the facility. Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 01/26/2023. The sample test for the sink, located in Room 24-13 a cubby room, identified on the facility sketch by letter “C”, tested at 6.4 ppbp/ug L, and sample test for the sink, located in Room 23-31 exercising room, identified on the facility sketch by Letter “F”, tested at 6.9 ppb/ L. which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance. LPA observed the the area of sink located in room 24-13, that was removed and in Room 23-31 facility removed the faucet and placed a signed “do not use this sink”. The Director is reporting that the classroom 23-31 is in use only for children exercising. Facility will provide water it children from the kitchen water filtration system and from room 24-13 cubby room, facility removed the sink and the sink will be replace no later than tomorrow. Licensee has posted testing results, in a location (cub room and observation room) 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 has notified 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 “C and "F". SUPERVISORS NAME: Rita Ramos LICENSING EVALUATOR NAME: Denise Miranda LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023 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 3 FACILITY NAME: UCLA INTERV PROG DEV HANDICAPPED INF & CHILDFACILITY NUMBER: 191600834 VISIT DATE: 02/16/2023 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 32During today’s visit LPA took pictures of the location of the water faucet (C) and (F). LPA received via email 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 copy of water testing results summary. . During today’s visit one Type B violation is being issued per PIN 21-21-CCP, Title 22 Regulations, Division 12, and 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. 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 will email and provide the Director with the Provider Information Notice (PIN) 21-21CCP and Lead Testing in Child Care Centers Frequently Asked Questions. The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring 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 (LIC809 & LIC809D), Appeal Rights (LIC9058), and Notice of Site Visit (LIC9213) were reviewed and provided to Dane Fritzmorris, Director. SUPERVISORS NAME: Rita Ramos LICENSING EVALUATOR NAME: Denise Miranda LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023 FACILITY NAME: UCLA INTERV PROG DEV HANDICAPPED INF & CHILD FACILITY NUMBER: 191600834 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/16/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/02/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(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 Requirement is not met as evidenced by: Based on observation, interview 1 2 3 4 5 6 7The facility will have the sink