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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830710
Report Date: 01/13/2023
Date Signed: 01/13/2023 12:01:52 PM


Document Has Been Signed on 01/13/2023 12:01 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:WRIGHTWOOD STATE PRESCHOOLFACILITY NUMBER:
364830710
ADMINISTRATOR:KIMBERLY MARTINFACILITY TYPE:
850
ADDRESS:1175 HIGHWAY 2TELEPHONE:
(760) 249-5828
CITY:WRIGHTWOODSTATE: CAZIP CODE:
92397
CAPACITY:24CENSUS: 21DATE:
01/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Facility Representative, Kate Morgan TIME COMPLETED:
12:25 PM
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On January 13, 2023, Licensing Program Analyst (LPA) Zirbes conducted an unannounced case management inspection. LPA Zirbes met with facility representative Katie Morgan. 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 (B) in an indoor drinking fountain has an ALE of 12.700ppb, outlet (C) has an ALE of 20.200ppb, outlet (D) has an ALE of 6.820ppb, outdoor drinking fountain (F) has an ALE of 6.250ppb. In addition, outlet F 30 has an ALE of 12.200ppb.

The facility has turned off the water for drinking fountains (B), (F) and (F30) until repairs can be made. The facility plans to replace all faucets and fixtures identified as having lead exceedance. Potable water is available to preschool children via a water cooler and water bottles during child care hours. See plan of correction for further corrective action (809D). The facility has notified authorized representatives of this corrective action in both languages English and Spanish.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, a type B deficiency is being cited (see next page, 809 D). Facility representative was provided a copy of the appeal rights. An exit interview was conducted with Facility representative, Katie Morgan.

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

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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 01/13/2023 12:01 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: WRIGHTWOOD STATE PRESCHOOL
FACILITY NUMBER: 364830710

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2023
Section Cited

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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 facility representative the effective fountains and faucets were immediately made inoperable. A portable waster source (water bottles) was provided to all students and staff. Replacement of the identified fixtures is already occurring. CCL will be notified once the faucets are replaced.
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This requirement was not met evidenced by: Based on the information received, outlet (B) an indoor drinking fountain has an ALE of 12.700ppb, outlet (F) an outdoor drinking fountain (F) has an ALE of 6.250ppb, and outlet F 30 has an ALE of 12.200ppb, 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 KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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