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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840755
Report Date: 06/29/2023
Date Signed: 06/29/2023 01:47:12 PM

Document Has Been Signed on 06/29/2023 01:47 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:FUNDAMENTALS PRESCHOOL ACADEMY, THEFACILITY NUMBER:
364840755
ADMINISTRATOR:EVELYN CHINCHILLAFACILITY TYPE:
840
ADDRESS:2424 KENDALL DRIVETELEPHONE:
(909) 887-1150
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 61TOTAL ENROLLED CHILDREN: 21CENSUS: 21DATE:
06/29/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Evelyn ChinchillaTIME COMPLETED:
02:10 PM
NARRATIVE
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On 6/29/2023 Licensing Program Analyst (LPA) Maddox conducted an unannounced case management inspection regarding - Lead Testing/Exceedance Levels. LPA Maddox met with Director, Evelyn Chinchilla. The purpose of today's inspection is to conduct a case management inspection, and to notify facility there has been a lead exceedance results reporting 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 water lead sampling test on 04/29/2023. Based on the records reviewed, water outlet (E), an outside drinking fountain, has an ALE of 58.000 (ppb) which is out of compliance with the allowable ALE of 5.5 ppb. According to Director, the water fountain has not been used since 2020. After the results of the water testing, the water fountain was capped off and is no longer in use. Center provides drinking water in the form of water coolers with disposable cups and individual cups labeled with each child's name. Director has notified authorized children's representatives of exceedance results and posted notice visible to parents. A type B citation was issued Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, 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, Evelyn Chinchilla.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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 06/29/2023 01:47 PM - It Cannot Be Edited


Created By: Donna Maddox On 06/29/2023 at 01:26 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: FUNDAMENTALS PRESCHOOL ACADEMY, THE
FACILITY NUMBER: 364840755

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2023
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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As a result of the high ppb reading, the water fountain has been capped off and no longer in use. There are now water cooler available for drinking water.
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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 58.00, which is out of compliance with the allowable ALE of 5.5 ppb. Outlet A was utilized in 2020. 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:Donna Maddox
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
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