192001280-2-10-2023-12-CC-JTAO-CNWUAY-20230210142532

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192001280
Report Date: 02/10/2023
Date Signed: 02/10/2023 02:25:39 PM

Document Has Been Signed on 02/10/2023 02:25 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	LANCASTER-NANCY CORY ELEMENTARY STATE PRESCHOOL		FACILITY NUMBER:	192001280
ADMINISTRATOR:	FOUNTAIN, KELLY		FACILITY TYPE:	850
ADDRESS:	3540 W. AVE K-4		TELEPHONE:	(661) 718-2816
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	48	CENSUS: 24	DATE:	02/10/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Christy Depasquale, Coordinator		TIME COMPLETED:	02:45 PM

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On 02/10/23, Licensing Program Analyst (LPA) Justeene Tamayo conducted a Case Management inspection in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA Tamayo met with Coordinator Christy Depasquale. The purpose of the inspection was disclosed, and entry was granted. Upon arrival LPA observed 24 preschool children in care, along with 5 Teachers.

During the inspection, LPA informed Coordinator, the results provided from SWRCB, indicated the facility had elevated levels of lead in the water in Classroom 31(PS1) preschool age drinking bubbler, the Kitchen Steam Pot faucet located at the elementary school Cafeteria, and the outside preschool playground drinking bubbler. The Department was notified of the Action Level Exceedance (ALE), levels for the Kitchen Steam Pot faucet (Sample A) 210.00 UG/L, Kitchen steam Pot faucet flushed (Sample A30) 22.0 UG/L, Room 31(PS1) drinking bubbler (Sample C) 8.3 UG/L and the outside playground drinking bubbler (Sample D) 7.5 UG/L. The SWRCB report sample listed facility inspected and collected sample on 01/14/23. Results were provided to facility on 02/03/23. Lab Job Number: 01051

LPA Tamayo has received required documents within the required timeframe.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LANCASTER-NANCY CORY ELEMENTARY STATE PRESCHOOL	FACILITY NUMBER: 192001280
	VISIT DATE: 02/10/2023

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LPA advised Coordinator, all water outlets tested with an ALE at the facility should be placed as out of service.

Per Coordinator, sample C drinking bubbler fountain in classroom 31 (PS1) has never been used. The facility uses filtered water with disposable cups. The outdoor playground bubbler has also never been used. Staff fill and provide water to preschool children through the filtered system with disposable cups for outdoor activities. Director has covered affected sinks and taped for inaccessibility to children present. Director has posted a sign at each water sink affected.

LPA toured the Elementary kitchen and observed the kitchen steam pot faucet off limits. Preschool children access food through the elementary cafeteria. The kitchen steam pot faucet has never been used. Food is prepared on the stove.

All affected faucets will be removed.

Once the repairs are made, Director will retest water for lead and notify LPA Tamayo of results after 3 weeks (21 day). Director is aware the lead levels shall not exceed 5.00 UG/L

Per Coordinator, the entire drinking bubbler fixtures will be removed.

An exit interview was conducted and a copy of this report was provided, along with a Notice of Site Visit and appeal rights to Coordinator Christy Depasquale.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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