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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750026
Report Date: 09/29/2022
Date Signed: 11/18/2022 04:17:23 PM

Document Has Been Signed on 11/18/2022 04:17 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:LITTLE MOUNTAIN PRESCHOOLFACILITY NUMBER:
367750026
ADMINISTRATOR:DOGERO, APRIL MARIEFACILITY TYPE:
840
ADDRESS:2915 LITTLE MOUNTAIN DRTELEPHONE:
(909) 882-1100
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator April DogeroTIME COMPLETED:
05:00 PM
NARRATIVE
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THIS REPORT IS AN AMENDED REPORT TO THE ONE GIVEN TO THE FACILITY ON SEPTEMBER 29, 2022.

On September 29, 2022, Licensing Program Analyst (LPA) Kendal Zirbes, conducted a unannounced case management inspection. The purpose of the case management was to respond to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA Zirbes met with the Administrator April Dogero, the purpose of the inspection was disclosed and entry was granted. Upon arrival six school age children were observed with one teacher providing supervision, the Administrator and additional support staff were present.



During the inspection, LPA Zirbes informed Director, that the results provided from SWRCB, indicated the facility had elevated levels of lead in one drinking fountain (E) located next to the school age and staff restrooms. The Department was notified that the Action Level Exceedance (ALE), levels were at 8.600. During the inspection, the Administrator confirmed the location of the drinking fountain was located in the hallway outside of the school age and staff restroom.

LPA advised Administrator, all water outlets tested with an ALE at the facility should be placed as out of service and water should be turned off. In addition children should be provided with an alternative potable water. During the inspection, LPA observed water pitchers and cups in the school age classroom. According to Administrator the water in the pitchers is obtained from the kitchen sink. The kitchen sink did not have a elevated lead level.

Per LPAs conversation with the Administrator, the drinking fountain (E) was utilized as a drinking fountain for the school age children in 2019/2020. Per Administrator, the drinking fountain is currently not being utilized and has not been utilized in since the start of the COVID 19 Pandemic approximately two to three years ago.
Report continued on page two
Lady King
Kendal Zirbes
DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER: 367750026
VISIT DATE: 09/29/2022
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Report continued from page one

During LPA's tour of the facility LPA observed the drinking fountain (E) was cover in plastic wrap and had a sign stating "Out of Order Do not use". During this inspection the water to the drinking fountain was turned off.

Per conversation with the Administrator, the Center is currently receiving quotes from licensed contractors to have the pipes replaced/removed and or the fixture replaced and/or removed. Per Administrator the drinking fountain (E) will continued to not be utilized.

Based on interviews and record review, the school age programs drinking fountain was utilized as a drinking fountain in 2019/2020. The drinking fountain was tested on August 10, 2022, and was found to have elevated lead levels. The ALE was reported as 8.600. Center was cited a Type B deficiency in accordance with the Written Directives. This poses/posed a potential risk to the persons in care. Refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted and the report was reviewed with Administrator April Dogero.
SUPERVISOR'S NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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Document Has Been Signed on 11/18/2022 04:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/18/2022 03:48 PM


Created By: Kendal Zirbes On 09/29/2022 at 04:03 PM
Link to Parent Document Below:
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: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER: 367750026

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/30/2022
Section Cited

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101700.3(b)(1) California Lead Action at Child Care Centers (b)Testing results with fractional ppb readings....(1) A result of 5.5ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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Based on LPAs interview and record review the drinking fountain (E) had a ALE of 8.600. This drinking fountain was utilized as a drinking fountain for the school age children until 2019/2020. This poses/posed a potential health, safety or personal rights risk to persons 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:Lady King
TELEPHONE:
LICENSING EVALUATOR NAME:Kendal Zirbes
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
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