197411721-3-1-2023-12-CC-AALH-CPHTZP-20230301141038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197411721
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:11:08 PM

Document Has Been Signed on 03/01/2023 02:11 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:	CROSSWIND COMMUNITY CHURCH/MOUNTAIN VIEW		FACILITY NUMBER:	197411721
ADMINISTRATOR:	AMY CURTIS		FACILITY TYPE:	840
ADDRESS:	41337-10TH ST WEST		TELEPHONE:	(661) 272-0681
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 9	DATE:	03/01/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	12:26 PM
MET WITH:	Director Amy Curtis		TIME COMPLETED:	02:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 01, 2023, Licensing Program Analyst (LPA) Andrew Alemoh, conducted a Case Management inspection in response to lead exceedance at the facility. Water lead testing results were received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW) indicating exceedance in (I) water outlet. LPA Alemoh disclosed the purpose of the inspection and was granted entry by the Site Director. LPA toured the facility and observed the location for the water outlet(I) according to the facility sketch. LPA toured the Discovery classroom, the facility is located on Crosswind Community Church Mountain View. Upon arrival LPA observed 1 staff and 9 children where present at the time. During the inspection, LPA Alemoh disclosed the lead results provided by SWRCB, indicating facility had elevated levels of lead in (I) area. The water outlet is not utilized for drinking nor food preparation. SWRCB collected water samples for lead testing and results were disclosed on 02/02/2023. Facility's lead testing results reported (I) with 8.700 of Action Level Exceedance (ALE). According to Staff interview children are provided with filtered water in a contained igloo container. Children bring there own water bottles to the day care facility. Every classroom has either a water dispense machine called "Primo" or a water filter system. According to the facility water outlet(I) is not utilized for food preparation. LPA observed individual water bottles, filtered water gallons and water igloos in each classroom and at the facility's staff room.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: CROSSWIND COMMUNITY CHURCH/MOUNTAIN VIEW	FACILITY NUMBER: 197411721
	VISIT DATE: 03/01/2023

NARRATIVE

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Facility has followed proper lead regulation directives and water outlet (I) is not used and not utilized for food preparation nor drinking. Therefore, no deficiencies will be cited.

An exit interview was conducted, a copy of this report, appeal rights and a Notice of Site Visit was provided to facility on this day.

This report shall be public record for three years and Notice of Site Visit is to be posted for 30 days.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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