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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360907170
Report Date: 09/08/2022
Date Signed: 09/08/2022 01:35:02 PM


Document Has Been Signed on 09/08/2022 01:35 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:CONCORDIA CHRISTIAN SCHOOLFACILITY NUMBER:
360907170
ADMINISTRATOR:DEBORA BARAJASFACILITY TYPE:
850
ADDRESS:420 AVENUE ETELEPHONE:
(760) 256-8979
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:57CENSUS: 21DATE:
09/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Debora BarajasTIME COMPLETED:
01:45 PM
NARRATIVE
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On September 08, 2022, Licensing Program Analysts (LPAs) Ibitoye, and King-Lewis, conducted a Case Management inspection in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA's met with the Director Debora Barajas, discuss the purpose of the inspection and entry was granted. Upon arrival there 21 children observed, and 3 staff present today.

During the inspection, LPA's informed Director, the results provided from SWRCB, indicated the facility had elevated levels of lead in the water faucet/drinking fountain “A” located in the outdoors playground area , drinking fountain “C” located in room 1 and drinking fountain “E” located in room 2, the Department was notified of the Action Level Exceedance (ALE), levels are at (A)-22.00 UG/L, (C)-12.00 UG/L, and (E)-7.40 UG/L The SWRCB report listed facility inspected and collected sample on 8/01/2022 lab testing number 466896 by Enthalpy Analytical.

Director provided LPA’s a copy of the water analytical report from Enthalpy Analytical showing the elevated levels of lead in the water faucet/drinking fountain “A” located in the outdoors playground area , drinking fountain “C” located in room 1 and drinking fountain “E” located in room 2,
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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 4


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: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360907170
VISIT DATE: 09/08/2022
NARRATIVE
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LPA's advised Director, all water outlets tested with an ALE level at the facility should be inoperable and children should be provided with an alternative water source. LPA's observed igloo outdoor in the playground area and pitcher dispensers in classroom 1 and 2. According to Director children are provided with drinking water from the refrigerator dispenser. LPA’s observed all 3 fountains has been place out of order and inaccessible to children. Director stated children will be provided water from filter refrigerator water dispenser.

Director advised LPA's the water fountain went into use on 08-08-22, fountains were not being used prior to that date due to COVID-19. According to Director, last day fountains were utilized by children was 09/06/2022 when she was notified of the high levels of lead being dispense.



See LIC 809D for cited deficiencies in accordance with the California Code Regulations Title 22, Division 12. LPAs informed the facility Director the facility is being cited for drinking water exceeded allowable levels of lead.

This is a Type B violation. The Director is aware a copy of the licensing report (LIC809) and the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.

In addition, all parents/guardians of currently enrolled children, shall be made aware of this report and parents shall sign acknowledgment of the center water testing results.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360907170
VISIT DATE: 09/08/2022
NARRATIVE
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An exit interview was conducted, appeal rights discussed, a copy of Notice of Site Visit, and a copy of this report was provided to Site Director, Debora Barajas on this date.

Director will submit written statement to the Palmdale Regional Office, the remediation of the planned for the drinking fountain A, C and E by 10/10/2022
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/08/2022 01:35 PM - It Cannot Be Edited

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: CONCORDIA CHRISTIAN SCHOOL
FACILITY NUMBER: 360907170

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2022
Section Cited

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Building and Grounds. The childcare center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees, and visitors.
This requirement is not met as evidenced by:
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Per SWRCB results facility was identified as having high lead level of 22.00 UG/L, 12.00 UG/L and 7.400 UG/L in drinking fountains “A” located in the outdoors playground area , drinking fountain “C” located in Room 1 and drinking fountain “E” located in Room 2 accessible to children. . LPA’s observed all 3 fountains has been place out of order and inaccessible to children with signage stating caution do not use the drinking fountain.
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 Director will submit written statement to the Palmdale Regional Office the remediation of the planned for the drinking fountain A, C and E by 10/10/2022

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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: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4