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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414003
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:42:37 PM


Document Has Been Signed on 12/20/2022 12:42 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:VOA GRANTEE/CARRISO PARK HEAD STARTFACILITY NUMBER:
197414003
ADMINISTRATOR:PATRICK BALLFACILITY TYPE:
850
ADDRESS:13100 HUBBARD STREETTELEPHONE:
(818) 362-8140
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:37CENSUS: 0DATE:
12/20/2022
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Rocio GomezTIME COMPLETED:
09:45 AM
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On December 20, 2022, Licensing Program Analyst (LPA) Isabel Ortega, 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 (C) water fountain in the outdoor play area. LPA Ortega disclosed the purpose of the inspection and was granted entry.

LPA toured the facility and observed the water fountain (C) according to facility sketch and observed water fountain was completely removed. Upon arrival no children and 5 staff were present.

During the inspection, LPA Ortega disclosed the lead results provided by SWRCB, indicating facility had elevated levels of lead in (C) area. The water fountain has been completely removed on 8/24/22. On 8/10/2022 the SWRCB collected water samples for lead testing. Facility's lead testing result's reported (C) water fountain in the play yard with 6.510 with Action Level Exceedance (ALE).

According to Staff interview children are provided with filtered water in igloos with individual disposable cups for indoor and outdoor play. According to facility water fountain (C) is not and never utilized for food preparation. LPA observed individual filtered drinking water dispenser and igloos with disposable cups at the facility.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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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: VOA GRANTEE/CARRISO PARK HEAD START
FACILITY NUMBER: 197414003
VISIT DATE: 12/20/2022
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The water fountain faucet labelled (C) according to the facility sketch was identified containing lead of 6.510. According to staff this water fountain (C) located in the play yard has not been utilized for drinking since 2018 and have always used the igloos with filtered water. According to Staff interview water fountain was turned off and children have been provided with filter water in igloos for outdoor play and indoor the water dispenser is available.

Facility has followed proper lead regulation directives and water fountain (C) is not used and not utilized for food preparation nor drinking. LPA observed water fountain removed entirely, facility provided removal report request on 8/22/2022 and removed entirely on 8/24/2022. 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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2