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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364810039
Report Date: 04/04/2023
Date Signed: 04/04/2023 02:26:15 PM

Document Has Been Signed on 04/04/2023 02:26 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:SBCUSD-HUNT PRESCHOOLFACILITY NUMBER:
364810039
ADMINISTRATOR:LATASHIA KELLYFACILITY TYPE:
850
ADDRESS:1342 PUMALO STREETTELEPHONE:
(909) 881-8178
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 23TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
04/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Facility Representative Delmy SchwartzmanTIME COMPLETED:
02:45 PM
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On April 4, 2023, Licensing Program Analyst (LPA) Zirbes conducted an unannounced case management inspection. LPA Zirbes met with facility representative Delmy Schwartzman. The purpose of today's inspection was 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 (A) an indoor sink with drinking fountain within the preschool classroom has an ALE of 26.0000ppb, and outlet (D) an outdoor drinking fountain on the side of the classroom has an ALE of 8.9000ppb. Information submitted to the Department reported the facility closed off outlets (A,D) on February 27, 2023. During this inspection, LPA observed key locked covers placed over outlets (A,D), however the water to the outlets was still on. LPA advised the facility, to turn off the water to outlets (A,D). Per written documentation received from San Bernardino School District, the facility plans to replace and retest outlets (A,D).
Per conversation with facility representative, outlet (A) an indoor sink with drinking fountain was utilized in the beginning of this school year (August 2022) up until February 2023 when the facility received information of the lead exceedance. Since the facility was notified of the lead exceedance, the drinking fountain was made inaccessible and bottled water and cups are provided to all students when engaged in indoor and outdoor play Per facility representative, outdoor drinking outlet (D) was not utilized by the children. Facility representative shared that all parents were notified of the lead exceedance via Classroom Dojo App. LPA observed the lead testing results were posted in the classroom. LPA advised the facility to post a notice on the outlets indicating the outlets had a lead exceedance, since the water is still turned on.

Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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Document Has Been Signed on 04/04/2023 02:26 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 04/04/2023 at 01:29 PM
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: SBCUSD-HUNT PRESCHOOL
FACILITY NUMBER: 364810039

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/18/2023
Section Cited

101700.3

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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 ...immediate response ...shall be required
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Per information received from the School District, outlets (A,D) were made inaccessible on 2/27/23. Bottled water and cups are provided to all students when engaged in indoor and outdoor play. Replacement of the identified fixtures and retesting will be occurring. The Department will be notified once the retesting has occurred.
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This requirement was not met as evidenced by: Based on the information received, outlet (A) had an ALE of 26.0000 and outlet (D) had an ALE of 8.9000, which is out of compliance with the allowable ALE of 5.5 ppb. Outlet A was utilized 8/2022 until 2/2023. This poses a potential health and safety risk for the children in care.
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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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


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: SBCUSD-HUNT PRESCHOOL
FACILITY NUMBER: 364810039
VISIT DATE: 04/04/2023
NARRATIVE
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Report continued from page one

Based on the information received, outlet (A) had an ALE of 26.0000 and outlet (D) had an ALE of 8.9000, which is out of compliance with the allowable ALE of 5.5 ppb. Outlet A was utilized August 2022 until February 2023. Therefore a type B citation was issued Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, written directives, refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Delmy Schwartzman.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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