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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360908874
Report Date: 06/05/2024
Date Signed: 06/05/2024 12:38:33 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/05/2024 12:38 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:VICTOR VALLEY CHRISTIAN PRESCHOOLFACILITY NUMBER:
360908874
ADMINISTRATOR/
DIRECTOR:		ROSE SANTIAGOFACILITY TYPE:
850
ADDRESS:15260 NISQUALLI ROADTELEPHONE:
(760) 241-7395
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 114TOTAL ENROLLED CHILDREN: 114CENSUS: DATE:
06/05/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Rose SantiagoTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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
On June 5, 2024, Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced case management inspection. LPA Diaz met with Preschool Director, Rose Santiago. The purpose of today's inspection was to conduct a case management inspection and to notify the facility that there is a lead exceedance for an Action Level Exceedance (ALE) of over 15.00 parts per billion (ppb) in the water at the facility. LPA conducted a safety inspection and took a census. LPA observed 56 children with 6 teachers. Facility Secretary was also present during visit.

LPA received and evaluated the school lead samples completed 10/20/22. Based on the records reviewed, outlets (A-E) have an ALE of 15.000ppb. On June 5, 2024, School maintenance has placed the water fountain as "out of service." LPA observed entire fountain covered with a black trash bag, taped with blue tape during this inspection. It is inaccessible to preschool children. There were 5 water testing samples: Outlets A-E completed between 5:35a and 5:42a. The ALE exceeded the reporting limit of 5.000ppb. Per Director, all other outlets tested are not used to provide drinking water to children in care.

Per facility director, no children will use the drinking fountain in the outdoor play area.

This inspection was conducted in person. The report was read and a copy provided to Preschool Director, Rose Santiago. Notice of Site Visit was provided and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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 2
Document Has Been Signed on 06/05/2024 12:38 PM - It Cannot Be Edited


Created By: Kristina Diaz On 06/05/2024 at 11:54 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: VICTOR VALLEY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 360908874

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2024
Section Cited
CCR
101700.3

1
2
3
4
5
6
7
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....result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance....Action Level Exceedance at any water outlet...is deemed not safe to drink
1
2
3
4
5
6
7
Drinking fountain was covered with a black trash bag and taped down with blue tape to make it inaccessible to children. Fountain will not be used until replaced and retested to meet compliance. Per Director, center will provide bottlde water for children until all outlets used for drinking water are replaced
8
9
10
11
12
13
14
 ...immediate response ...shall be required
This requirement was not met as evidenced by: information received, outlet (E) had an ALE of 15.000ppb which is out of compliance with the allowable ALE of 5.5ppb. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
and retested to meet compliance. Lead Water Sampling will be completed again using the provided Child Care Center Sampling Checklist Form (LIC 9276). Director will also review PIN 21-21-CCP for further clarification. Director will notify LPA if due date of 7/12/2024 is insufficient time for correction.

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:Claretta Yates
LICENSING EVALUATOR NAME:Kristina Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2