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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409136
Report Date: 03/24/2023
Date Signed: 03/24/2023 03:45:07 PM


Document Has Been Signed on 03/24/2023 03:45 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:NOTRE DAME PRESCHOOLFACILITY NUMBER:
197409136
ADMINISTRATOR:ANGELICA M RODRIGUEZFACILITY TYPE:
850
ADDRESS:21704 GOLDEN TRIANGLE RD.#120TELEPHONE:
(661) 255-0053
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:44CENSUS: 31DATE:
03/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Angelica RodriguezTIME COMPLETED:
09:30 AM
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On 3/24/2023 Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced case management inspection. LPA met with Administrator Angelica Rodriguez and tour the facility according to the facility sketch. The purpose of today's inspection is to conduct a case management inspection regarding lead exceedance referred to as 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 recent sample tested on 2/17/2023. The water lead sampling test results are based on the records reviewed water fountain B in the facility next to the restrooms in the hallway, the results are ALE 11 ppb, this is exceeding the ALE acceptable water 5.5 ppb level.

Facility has replaced the water pipes (B) and continue to placed the water fountain out of service. According to facility water fountain (B) is not utilized for drinking water nor food preparation. According to facility water fountain (B) has not been in use but facility was considering to utilized the water fountain in the future if results were cleared. The water fountain (B) has been disabled until fountain can be retested and results are under 5.5 ppb.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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: NOTRE DAME PRESCHOOL
FACILITY NUMBER: 197409136
VISIT DATE: 03/24/2023
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Filtered uncontaminated water from the kitchen is readily available to children during hours of operation. An IGLOO/pitcher water jug with uncontaminated drinking water levels and disposable cups/water bottles are readily available to children during day care hours. The facility has posted and emailed authorized representatives (parents, legal guardians, ect.) of water sample results ALE.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiency is being cited. An exit interview was provided, facility was provided with a copy of this report, appeal rights and notice of site visit (NOA).

This report shall be made available to the public upon request. The Notice of Site Visit (NOA) is required to be posted for 30 days.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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