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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801077
Report Date: 02/21/2023
Date Signed: 02/21/2023 10:41:17 AM


Document Has Been Signed on 02/21/2023 10:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
153801077
ADMINISTRATOR:ARNECKE, KRISTENFACILITY TYPE:
850
ADDRESS:329 S. MILL ST.TELEPHONE:
(661) 823-7740
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:64CENSUS: DATE:
02/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kristen ArneckeTIME COMPLETED:
10:50 AM
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On 02/21/2023 Licensing Program Analyst (LPA) Beneroso conducted an unannounced case management inspection. LPA Beneroso met with Director Kristen Arnecke and announced the purpose of today's inspection. This inspection is to conduct a case management inspection and to notify facility there has been a lead exceedance results reporting an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

Palmdale Regional Office received notification of water lead exceedance at the facility resulting from a water lead sampling test on 12/30/2022. Based on the records reviewed water fountain located in the classroom one, sample A has an ALE of 15 ppb, water fountain located in classroom two, sample D has an ALE of 9.5.ppb, water fountain located in classroom three, sample E has an ALE of 6.1 These areas in the Preschool classrooms, lead is exceeding the Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water.

Water fountains was never utilized for drinking nor utilized for food preparation. The areas identified on the facility sketch as A, D and E are not reachable by children. Facility provides filtered water in individual cups that children bring from home during day care hours of operation.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801077
VISIT DATE: 02/21/2023
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As plan of correction, facility will be placing metal caps on the drinking fountains as they are not planning on using them in the future.

Facility submitted authorized children's representatives notification of exceedance results and posted notice visible to parents.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiency will being cited. Facility was provided a copy of the appeal rights. An exit interview was conducted with facility Director.

This report shall be made available to the public upon request. The Notice of Site Visit is provided an required to be posted for 30 days. Appeal rights and report have been provided to facility on this day.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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