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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409310
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:02:22 PM


Document Has Been Signed on 02/14/2023 12:02 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:LANCASTER-SIERRA ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
197409310
ADMINISTRATOR:FOUNTAIN, KELLYFACILITY TYPE:
850
ADDRESS:747 WEST AVE. J-12TELEPHONE:
(661) 942-4382
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:96CENSUS: 43DATE:
02/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Coordinator-Christy DepasqualeTIME COMPLETED:
12:20 PM
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On 2/14/2023 Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management inspection. LPA Pittman met with Coordinator Christy Depasquale 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 15.0 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 1/14/2023. Based on the records reviewed, the large steam pot (A) in the kitchen café has an ALE of 15.0 ppb. This area in the kitchen cafe lead is exceeding the Action Level Exceedance (ALE) of over 5.0 parts per billion (ppb) in the water.

Lead Staff Rhea Smith confirmed that the large steam pot was never utilized for drinking nor for food preparation. This area is identified on the facility sketch as (A) is not reachable by children. Facility provides filtered water in disposable cups and individual water bottles during day care hours of operation.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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: LANCASTER-SIERRA ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197409310
VISIT DATE: 02/14/2023
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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 be cited. Facility was provided a copy of the appeal rights. An exit interview was conducted with facility’s Coordinator Christy Depasquale.

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: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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