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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805043
Report Date: 08/13/2024
Date Signed: 08/13/2024 04:11:54 PM


Document Has Been Signed on 08/13/2024 04:11 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:PALM VALLEY PRESCHOOLFACILITY NUMBER:
334805043
ADMINISTRATOR:JENNIFER TRAUBFACILITY TYPE:
850
ADDRESS:35-525 DA VALL DRIVETELEPHONE:
(760) 328-0861
CITY:RANCHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:178CENSUS: 0DATE:
08/13/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Jennifer Traub TIME COMPLETED:
04:31 PM
NARRATIVE
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On August 13, 2024, at 3:43 PM, Licensing Program Analyst’s (LPA) Anastasia Flores, made an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Director, Jennifer Traub, and proceeded to tour the facility. Also present in the facility were 0 preschool children and 10 staff. Facility has not opened for the new school year and will open on 8/14/24. On 08/13/24, LPA Anastasia Flores interviewed the director, and examined the faucet and deemed an Action Level Exceedance. Facility provided facility sketch and plan of correction via email on 08/08/24. The required signed and dated forms (LIC 9275/9276) were submitted to Community Care Licensing via email on 08/08/24.

Label J-CF-P classroom 4: faucet L reported with 23.00 ppb or greater lead exceedance levels were as follows:

1 faucet/used for handwashing identified as having high levels of lead read at 23 ppb. The faucet was in the classroom which is the toddler classroom in building 9. The faucet was flushed and retested on 5/02/23, results were 3.1ppb.

Based on records review and information received, and current policies and procedures for the Department, the facility is being cited for having a lead exceedance in water fountain labeled letter A, under the Written Directives, Section 101700.3 (b) (1) California Lead Action Level at Child Care Centers. This poses a potential health, safety, or personal rights risk to the children in care.

An exit interview was conducted, a copy of this report, 809D and appeal rights were handed to facility Director, Jennifer Traub. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/13/2024 04:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: PALM VALLEY PRESCHOOL
FACILITY NUMBER: 334805043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2024
Section Cited

101700.3(b)(1)

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101700.3 (b) (1) California Lead Action Level at Child Care Centers 101700.3 (b) (1) Written Directives...A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met as evidence by:
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Facility has previously corrected the hand washing station, LPA verified with the report sent to LPA via email on 08/09/24. No further corrections necessary.
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Based on records review and interviews, facility tested over the Action Level Exceedance, in one hand washing station located on the toddler classroom. This poses a potential health, safety, or personal rights risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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