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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360904386
Report Date: 09/12/2023
Date Signed: 09/12/2023 10:37:24 AM


Document Has Been Signed on 09/12/2023 10:37 AM - 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:LAKE ARROWHEAD COOPERATIVE PRESCHOOLFACILITY NUMBER:
360904386
ADMINISTRATOR:JODY AUTENFACILITY TYPE:
850
ADDRESS:351 N. STATE HIGHWAY 173TELEPHONE:
(909) 337-8686
CITY:LAKE ARROWHEADSTATE: CAZIP CODE:
92352
CAPACITY:24CENSUS: 7DATE:
09/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Jodie Auten TIME COMPLETED:
10:50 AM
NARRATIVE
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On September 12, 2023, Licensing Program Analyst (LPA) Zirbes conducted an unannounced case management inspection. LPA Zirbes met with Administrator Jodi Auten. The purpose of today's inspection was to conduct a case management inspection, and to notify the facility there has been a lead exceedance referred for an Action Level Exceedance (ALE) of over 5.5 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 conducted in May 2023. Based on the records reviewed, outlet (C) an indoor sink faucet within the preschool bathroom had an ALE of 10.00 and outlet (D) an indoor drinking fountain had an ALE of 9.70. Information submitted to the Department on July 15, 2023, reported the facility was no longer using outlets (C) and (D). The facility was not in session between the June and September 2023.
During this inspection, LPA observed the water to outlet D was turned off and a water filter has been installed. Outlet C is in use however is only being used for handwashing. Potable water is available to preschool children via personal water bottles filled at the student’s home and water from the kitchen outlets. Kitchen outlets were tested, and the ALE was within the allowable limits.
Per information received from the facility drinking fountain (D) was previously utilized by the preschool children as a drinking fountain. In addition, outlet (C) was previously used to refill the students water bottles. Since results were received the outlets were taped off and identified as having lead exceedance. Per Administrator, a lead removal filter was installed on drinking fountain (D) and outlet (C) is no longer being used to fill children water bottles. The facility is in the process of retesting the outlets.
LPA advised the Center to post the lead testing results on the parent board in the classroom.
Based on the information received, outlet (C) an indoor sink faucet within the preschool bathroom had an ALE of 10.00 and outlet (D) an indoor drinking fountain had an ALE of 9.70. Per interviews both outlets were utilized as a drinking source for the preschool children. Therefore, a type B citation was issued per Title 22, Division 12, Chapter 1, of the California Code of Regulations, written directives, as this posed a potential risk to the children in care. Refer to LIC 809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Administrator Jodie Auten.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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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Document Has Been Signed on 09/12/2023 10:37 AM - 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: LAKE ARROWHEAD COOPERATIVE PRESCHOOL
FACILITY NUMBER: 360904386

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2023
Section Cited

101700.3(b)(2)

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101700.3 (b)(2): Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.” This requirement was not met as evidenced by:
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Per Administrator, bathroom sink (C), is no longer being utilized to fill water bottles and is only used for hand washing. A lead removal filter was installed on drinking fountain (D). The facility will ensure the filter is changed as required by the manufactures instructions.
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Licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for outlets (C, D). Per WD 101700.3. outlet (C,D) are not deemed safe to drink. This is a potential risk to the health, safety, personal rights of the children in care.
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The facility is in the process of having the outlets retested. Children will bring full water bottles from home each day. If a child’s water bottle needs to be refilled the facility will utilize water from the kitchen sink faucet (A), which was tested and found to have an allowable ALE.

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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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
LIC809 (FAS) - (06/04)
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