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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750148
Report Date: 03/01/2023
Date Signed: 03/01/2023 11:47:17 AM

Document Has Been Signed on 03/01/2023 11:47 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CCRC 10TH STREET HEAD STARTFACILITY NUMBER:
197750148
ADMINISTRATOR:BEATRIZ ZAMORANO-PEDREGONFACILITY TYPE:
830
ADDRESS:44236 10TH STREET WESTTELEPHONE:
(661) 494-7999
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 2DATE:
03/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Angelee Oster, Early Learning Supervisor TIME COMPLETED:
12:00 PM
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On 03/01/23, 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 Early Learning Supervisor Angelee Oster. The purpose of the inspection was disclosed, and entry was granted. Upon arrival LPA observed 2 infants in care along with 2 teachers.

During the inspection, LPA informed Supervisor, the results provided from SWRCB, indicated the facility had elevated levels of lead in the water in Infant Classroom 2 hand washing sink located in the infants bathroom, and Toddler Classroom 5 hand washing sink located in the toddlers bathroom. The Department was notified of the Action Level Exceedance (ALE), levels for the infant hand washing sink (Sample D) 8.360 UG/L and toddler hand washing sink (Sample Y) 6.570 UG/L. The SWRCB report sample listed facility inspected and collected sample on 02/06/23. Results were provided to facility on 02/14/23 . Lab Job Number:01051

LPA Pittman has received required documents within the required timeframe.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750148
VISIT DATE: 03/01/2023
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LPA advised Supervisor all water outlets tested with an ALE at the facility should be placed as out of service.

Per Supervisor, sample D and sample Y are only used for hand washing. Sample D hand washing faucet was last used on 02/05/23. Sample Y hand washing faucet has never been used.

Children drink water from the facilities filtered water system. Supervisor has covered affected sinks and taped for inaccessibility to children present. Supervisor has posted a sign at each water sink affected.

All affected faucets have been removed and replaced. Supervisor will retest water for lead and notify LPA Pittman of results after 3 weeks (21 day). Supervisor is aware the lead levels shall not exceed 5.00 UG/L

No deficiencies have been given at this time.

An exit interview was conducted and a copy of this report was provided, along with a Notice of Site Visit and appeal rights to Early Learning Supervisor Angelee Oster.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC809 (FAS) - (06/04)
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