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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202079
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:12:25 PM


Document Has Been Signed on 11/29/2022 12:12 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SMALL WORLD NURSERYFACILITY NUMBER:
191202079
ADMINISTRATOR:MILLER, LINDAFACILITY TYPE:
850
ADDRESS:26640 NORTH BOUQUET CANYON RDTELEPHONE:
(661) 296-1155
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:85CENSUS: DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Michelle Moyer, Site DirectorTIME COMPLETED:
01:35 PM
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On 11/27/22, Licensing Program Analysts (LPAs) Villa and Beneroso conducted a Case Management inspection in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPAs Villa and Beneroso met with the Michelle Moyer, site director. The purpose of the inspection was disclosed, and entry was granted. Upon arrival, LPAs observed 19 children and 4 staff present.

LPA Beneroso received sample results for the sink faucets (Samples A, B, C, C30 & D) on November 01, 2022. Facility was originally tested on September 27, 2022. Sample A, sink faucet had a reading of 11.0 UG/L. Sample B, sink faucet had a reading of 53.0 UG/L. Sample C, sink faucet had a reading of 17.0UG/L. Sample C30, sink faucet had a reading of 6.0 UG/L and Sample D, sink faucet had a reading of 9.7 UG/L. Per site director, all outlets (Sample A,B,C, C30 and D) have been used for hand washing only since Covid-19 Started in March 2020. All outlets (Sample A, B, C, C30 and D) had proper signs displaying they are out of service for drinking.

Per director, the drinking spout has not been used since Covid-19 and will be permanently be removed. Site director will send proof to LPA Beneroso of all drinking spouts removed by Friday, December 2nd.

No citations or deficiencies were issued during this visit.

An exit interview was conducted, and a copy of this report was provided along with a Notice of Site Visit and appeal rights to site director, Michelle Moyer.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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