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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492786
Report Date: 07/07/2023
Date Signed: 07/07/2023 10:22:35 AM

Document Has Been Signed on 07/07/2023 10:22 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:MONTESSORI OF SANTA CLARITAFACILITY NUMBER:
197492786
ADMINISTRATOR:BRANDY BLACK-PEREAFACILITY TYPE:
830
ADDRESS:27757 BOUQUET CANYON ROADTELEPHONE:
(661) 296-0175
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 4DATE:
07/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brandy Black-PereaTIME COMPLETED:
10:30 AM
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On 7/07/2023 Licensing Program Analysts(LPAs) Isabel Ortega and Evelyn Garcia conducted an unannounced case management Lead exceedance inspection. LPAs met with Director Brandy Black-Perea. The purpose of today's inspection is to conduct a case management Lead exceedance inspection, and to notify facility there has been a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water fountain (E) located by the hallway infant room at the facility.

Palmdale Regional Office received notification of water lead exceedance from the facility resulting from a recent water sample water lead sampling tested on 5/26/2023. Based on the record reviewed outlet (E) located indoors is not accessible to the children. The (E) fountain is barricaded by a closet with sliding door.

According to Director water fountain (E) has never been utilized for drinking nor food preparation and found (E) will continue to be shut off until repairs can be made or removal of fountain is completed. Filter water from a water dispenser is available to children in care. Infant bottles bought from home, zippy cups and /or disposable cups are available to children during day-care hours of operation. The Director has notified authorized representatives of this corrective action plan and a out of service sign has been posted.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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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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: MONTESSORI OF SANTA CLARITA
FACILITY NUMBER: 197492786
VISIT DATE: 07/07/2023
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies will be cited today. An exit interview was conducted with Director and LPAs provided a copy of the appeal rights, copy of his report and notice of site visit.

This report shall be made available to the public upon request. The Notice of Site Visit is provided a required to be posted for 30 days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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