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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403566
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:03:36 PM

Document Has Been Signed on 01/31/2023 01:03 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:KINDERCARE LEARNING CENTERFACILITY NUMBER:
197403566
ADMINISTRATOR:GENESIS BENITEZFACILITY TYPE:
850
ADDRESS:44400 FOXTONTELEPHONE:
6619481767
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 57DATE:
01/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Director Genesis BenitezTIME COMPLETED:
01:20 PM
NARRATIVE
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On 01/31/2023 Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced case management inspection. LPA Joselito L. Del Mundo met with Director Genesis Benitez. The purpose of today's inspection is to conduct a case management inspection, and to notify them 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 recent water lead sampling test. Based on the records reviewed outlet (B) in an indoor kitchen’s small sink has an ALE of 18 ppb.

Site Supervisor conducted repairs on water outlet (B) for two days which are on 01/28 and 29, 2023. Director Benitez stated that they were advised to conduct a fixture flushing on outlet (B) for four weeks until outlet (B) is prepared for water sampling again. The first flushing started on 01/30/2023 (30 seconds, 4 times a day) and will continue until the fourth week. Outlet (B) will be retested for water sampling after the four week of flushing is completed. A flushing tracking sheet was provided to LPA Joselito L. Del Mundo. Drinking water is being provided only from sinks and drinking fountains on site that have been evaluated and confirmed to be below the Action Level for lead. Bottled water will also be provided to preschool and school age children (see plan of correction for further corrective action, 809D). The director has notified authorized representatives of this corrective action in both languages English and Spanish.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, a type B deficiency is being cited (see next page, 809 D). Director Benitez was provided a copy of the appeal rights. An exit interview was conducted with Director Genesis Benitez. This report shall be made available to the public upon request. The Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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 01/31/2023 01:03 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 01/31/2023 at 11:00 AM
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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 197403566

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/28/2023
Section Cited

101700.3

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101700.3 California Lead Action Level at Child Care Centers (a) California’s Action Level for lead in water at Child Care Centers is 5 ppb. (1) 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: based on the information
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Director Benitez is currently conducting flushing of outlet (B) for 30 seconds, 4 times in a day until the fourth week. Drinking and bottled water will be provided to preschool and school age children. Outlet (B) will be retested after the fourth week. Results will be provided to LPA Del Mundo thru email.
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received from outlet, (B) in an indoor kitchen’s small sink has an ALE of 18 ppb,
which is out of compliance with the allowable ALE of 5.5 ppb. This poses a potential health and safety risk for 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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023


LIC809 (FAS) - (06/04)
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