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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364810046
Report Date: 04/04/2023
Date Signed: 04/04/2023 11:48:49 AM

Document Has Been Signed on 04/04/2023 11:48 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SBCUSD-WILSON PRESCHOOLFACILITY NUMBER:
364810046
ADMINISTRATOR:LATASHIA KELLYFACILITY TYPE:
850
ADDRESS:2894 BELLE STREETTELEPHONE:
(909) 881-8253
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 19DATE:
04/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Facility Representative Martha Osita TIME COMPLETED:
12:00 PM
NARRATIVE
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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 Martha Osita. 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 (C) an outdoor drinking fountain within the preschool outdoor play space has an ALE of 5.7000ppb, outlet (D) an outdoor drinking fountain within the preschool outdoor play space has an ALE of 6.2000ppb, and outlet (E) an outdoor bottle filling station has an ALE of 5.9000ppb. The facility closed off outlets (C), (D) and (E) on February 27, 2023. During this inspection LPA observed key locked covers place over outlets (C) and (D), however the water to the outlet was still on. Outlet E was uncovered and water accessible. Per conversation with three facility staff members, outlet (E) was previously covered with a plastic bag however due to the recent high winds, the bag fell off. During this inspection, a new bag was placed over outlets (C,D,E), therefore the outlets were inaccessible. LPA advised the facility, to turn off the water to outlets (C,D,E). Per written documentation received from San Bernardino School District, the facility plans to replace and retest drinking fountains (C,D) and bottle filling station (D). Per conversation with facility representative, currently when the children go outdoors to play, potable water is available via bottled water. Facility representative shared that all parents were notified of the lead exceedance via Classroom Dojo App. During this inspection, LPA observed the children engaged in outdoor play and bottled water was readily available to the children. Facility representative shared that the drinking fountains were utilized prior to the COVID 19 pandemic. Previous licensing reports indicated the water fountains were utilized by the children in care. LPA advised the facility to post a notice on the outdoor outlets indicating the outlets had lead exceedance, since the water is still turned on. LPA advised the facility to also post the notice inside the classroom.

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 11:48 AM - It Cannot Be Edited


Created By: Kendal Zirbes On 04/04/2023 at 10:40 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: SBCUSD-WILSON PRESCHOOL
FACILITY NUMBER: 364810046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2023
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 (C,D,E) were made inaccessible on 2/27/23. Water bottles were provided to all students when engaged in 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 evidenced by: Based on the information received, outlet (C,D) outdoor drinking fountains had an ALE of 5.7000, 6.2000. Outlet (E) had an ALE of 5.9000, which is out of compliance with the allowable ALE of 5.5 ppb. 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-WILSON PRESCHOOL
FACILITY NUMBER: 364810046
VISIT DATE: 04/04/2023
NARRATIVE
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Report continued from page one
In addition, LPA advised the facility to turn off the water to the outlets, since the bag has been removed previously.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, written directives a type B deficiency is being cited, 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 Martha Osita.

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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