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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419458
Report Date: 12/15/2022
Date Signed: 12/15/2022 04:33:10 PM

Document Has Been Signed on 12/15/2022 04:33 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:VOLUNTEERS OF AMERICA,WILEY CANYON HEAD STARTFACILITY NUMBER:
197419458
ADMINISTRATOR:ROCIO GOMEZFACILITY TYPE:
850
ADDRESS:24240 LA GLORITA CIRCLETELEPHONE:
(818) 897-4124
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY: 51TOTAL ENROLLED CHILDREN: 51CENSUS: 0DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Prisma RubioTIME COMPLETED:
04:45 PM
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On December 15, 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 (A) water outlet. LPA Ortega disclosed the purpose of the inspection and was granted entry by the Site Supervisor.

LPA toured the facility and observed the location for the water outlet(A) according to the facility sketch. LPA toured classroom 28 and 29, facility is located on Wiley Canyon Head Start. Upon arrival four staff and no children were present.

During the inspection, LPA Ortega disclosed the lead results provided by SWRCB, indicating facility had elevated levels of lead in (A) area. The water outlet is not utilized for drinking nor food preparation. SWRCB collected water samples for lead testing and results were disclosed on 12/05/2022. Facility's lead testing results reported (A) with 7.8 of Action Level Exceedance (ALE).
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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: VOLUNTEERS OF AMERICA,WILEY CANYON HEAD START
FACILITY NUMBER: 197419458
VISIT DATE: 12/15/2022
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According to Staff interview children are provided with filtered water in a disposable cup for indoors and for outdoor play children are provided with filter water contained in a igloo container. According to the facility water outlet(A) is not utilized for food preparation. LPA observed individual drinking cups, filled filtered water gallons and water igloos in each classroom and at the facility's staff room.

The water outlet labelled (A) according to the facility sketch was identified containing lead of 7.8. According to staff water outlet (A) located on the side of the Elementary School premises has not been utilized for drinking nor food preparation.

Facility has followed proper lead regulation directives and water outlet (A) 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.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC809 (FAS) - (06/04)
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