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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750001
Report Date: 02/22/2024
Date Signed: 02/22/2024 04:47:09 PM

Document Has Been Signed on 02/22/2024 04:47 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:OAK TREE LEARNING CENTERFACILITY NUMBER:
367750001
ADMINISTRATOR:CARTER, JENNIFERFACILITY TYPE:
850
ADDRESS:680 W 40TH STTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 23DATE:
02/22/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Melissa DavisTIME COMPLETED:
05:00 PM
NARRATIVE
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On February 22, 2024 , Licensing Program Analyst (LPA) Babatunde Ibitoye, conducted a Case Management inspection in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA met with Director Melissa Davis, LPA discussed the purpose of the inspection, and entry was granted. Upon arrival, there were 23 children observed, and 3 staff were present today.

During the inspection, LPA informed Director, the results provided by SWRCB, indicated the facility had elevated levels of lead in the water Sink faucet-PS Kitchen “A” located in the Kitchen, the Department was notified of the Action Level Exceedance (ALE), levels are at (A)-12.00 UG/L .The SWRCB report listed facility inspected and collected sample on 12/16/2023 lab testing number 498722 by Enthalpy Analytical.

The director provided LPA a copy of the water analytical report from Enthalpy Analytical showing the elevated levels of lead in the water Sink faucet-PS Kitchen “A” located in the Kitchen. LPA advised the Director that water outlets tested with an ALE level at the facility should be made Inaccessible and children should be provided with an alternative water source for cooking. Potable water is available to preschool children. The director has made Sink faucet- PS Kitchen ''A'' located in the Kitchen Inaccessible until replacement can be made by 03/29/2024. See the plan of correction for further corrective action 809D). the director will 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 LIC 809 D). Director was provided a copy of the appeal rights. An exit interview was conducted with Director Melissa Davis

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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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 02/22/2024 04:47 PM - It Cannot Be Edited


Created By: Babatunde Ibitoye On 02/22/2024 at 04:09 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: OAK TREE LEARNING CENTER
FACILITY NUMBER: 367750001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited

101700.3

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(a) California's Action Level for lead in water at Child care centers is 5 ppb. (b)Testing results will fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest while number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action level Exceedance(ALE). (c) If ALE at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required.
This requirement is not met as evidenced by:
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According to Director, flixture (A) will be replaced and retested. During inspection Director shut off water sink faucet PS Kitchen (A) Inacceaseable . Also,Do not use sign was placed on identified area until repairs can be made by due date.
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Per water testing results identifying facility with lead level exceeding 5.5 ppb in area A 12.0 ppb which is out of compliance allowable ALE of 5.5 ppb. This poses a potential health and safety risk to children in care.
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Facility has agreed to retest water and submit a copy of the report faxed or email to the Palmdale Regional Office by due date.

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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:Claretta Yates
LICENSING EVALUATOR NAME:Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


LIC809 (FAS) - (06/04)
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