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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910926
Report Date: 01/17/2023
Date Signed: 01/17/2023 02:33:24 PM

Document Has Been Signed on 01/17/2023 02:33 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:TEDDY BEAR TYMES #2FACILITY NUMBER:
360910926
ADMINISTRATOR:DREW, LINDAFACILITY TYPE:
830
ADDRESS:900 E. GILBERT STREET, BLDG #8TELEPHONE:
(909) 387-0550
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 12DATE:
01/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Facility Representative Annette Ponce TIME COMPLETED:
02:05 PM
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On January 17, 2023, Licensing Program Analyst (LPA) Zirbes conducted an unannounced case management inspection. LPA Zirbes met with facility representative Annette Ponce. The purpose of today's inspection is to conduct a case management inspection, and to notify the facility there has been a lead exceedance referred for an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

Palmdale Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on the records reviewed outlet (F) in outdoor drinking fountain within the Infant/Toddler outdoor play space has an ALE of 9.600ppb.

The facility has turned off the water for drinking fountain (F) until repairs can be made. The facility plans to replace or remove outdoor drinking fountain (F) which was identified as having lead exceedance. Potable water is currently available when outdoors via sippy cups/water bottles filled up from a water obtained through Arrowhead water delivery service. Per conversation with the facility representative, outdoor drinking fountain (F) was not utilized by infant/toddlers as a drinking fountain. Due to the physical development of the infant/toddlers, the teachers have always brought out sippy cups/water bottles to the outdoor play space. Per facility representative, if the sippy cup needed to be filled up, the sippy cup was filled via an indoor faucet. Therefore per facility representative, outdoor drinking fountain (F) was not utilized. Per facility representative the children enrolled in the preschool program did not utilize the outdoor play space where drinking fountain (F) was located.

Based on the interview with the facility representative outdoor drinking fountain (F) was not utilized for drinking water nor food preparation in the past or currently.

An exit interview was conducted with Facility representative, Annette Ponce.

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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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