<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409311
Report Date: 02/10/2023
Date Signed: 03/01/2023 01:01:54 PM


Document Has Been Signed on 03/01/2023 01:01 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/27/2023 11:52 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This report is being amended on 02/27/23 for the purpose to downgrade the Type A citation to a Type B citation from the visit that was conducted on 02/10/23. Licensing Program Analyst (LPA) Justeene Tamayo conducted a Case Management inspection in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA Tamayo met with the Lead Teacher Christine Villa. The purpose of the inspection was disclosed, and entry was granted. Upon arrival LPA observed 22 preschool children in care, along with 5 Teachers. Coordinator Christy Depasquale came to the facility shortly after.

During the inspection, LPA informed Coordinator, the results provided from SWRCB, indicated the facility had elevated levels of lead in the water in Classroom 1 (PS1) Room 27 preschool age drinking bubbler and the Kitchen Steam Pot faucet located at the elementary school Cafeteria. The Department was notified of the Action Level Exceedance (ALE), levels for the Kitchen Steam Pot facuet (Sample A) 17.0 UG/L and PS1 drinking bubbler (Sample C) 6.5 UG/L. The SWRCB report sample listed facility inspected and collected sample on 01/14/23. Results were provided to facility on 02/03/23. Lab Job Number: 01051

LPA Tamayo has received required documents within the required timeframe.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LANCASTER-WEST WIND ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197409311
VISIT DATE: 02/10/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA advised Lead Teacher, all water outlets tested with an ALE at the facility should be placed as out of service.

Per Lead Teacher, sample C drinking bubbler fountain in classroom 27 (PS1) has never been used. The facility uses filtered water with disposable cups. Director has covered affected sinks and taped for inaccessibility to children present. Director has posted a sign at each water sink affected. LPA toured the Elementary kitchen and observed the kitchen steam pot faucet off limits. Preschool children access food through the elementary cafeteria. The kitchen steam pot faucet was used for food preparation. Last time the kitchen steam pot faucet has been used was around August-September of 2022. The faucet has remained inaccessible and is not being used. Although the faucet has not been used since 2022, this is a potential risk to children in care. Facility has been cited a Type B Citation. Please see LIC809-D.

All faucets will be removed.

Once the repairs are made, Director will retest water for lead and notify LPA Tamayo of results after 3 weeks (21 day). Director is aware the lead levels shall not exceed 5.00 UG/L

Per Coordinator, the entire drinking bubbler fixtures will be removed.

An exit interview was conducted and a copy of this report was provided, along with a Notice of Site Visit and appeal rights to Coordinator Christy Depasquale.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/01/2023 01:03 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/27/2023 12:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: LANCASTER-WEST WIND ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197409311

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/10/2023
Section Cited

1
2
3
4
5
6
7
101700.3 California Lead Action Level at Child Care Centers(a) California's Actions Level for lead in water at Child Care Centers is 5 ppb..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:
1
2
3
4
5
6
7
All faucets affected will be removed. Director is aware to retest the lead before food is being prepared. Director has posted an out of order sign and covered the kitchen steam faucet for inaccessibility. Director will send new results to LPA Tamayo after the 21 day timeframe once faucets have been replaced.
8
9
10
11
12
13
14
Per SWRCB results facility sample A had high levels of lead. Kitchen steam pot facuet water was used for food preparation. Last time food was prepared was August-September of 2022. This can pose a potential risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3