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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290314
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:31:55 PM

Document Has Been Signed on 02/17/2023 01:31 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:YWCA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191290314
ADMINISTRATOR:CARRILLO, ROCIOFACILITY TYPE:
850
ADDRESS:1200 NO. MACLAYTELEPHONE:
(818) 365-6881
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 36DATE:
02/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ramona Perez, Interim Site DirectorTIME COMPLETED:
01:45 PM
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On 02/17/23, Licensing Program Analyst (LPA) Justeene Tamayo conducted a Case Management inspection in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA Tamayo met with Teacher Yadira Acevedo. The purpose of the inspection was disclosed, and entry was granted. Upon arrival LPA observed 36 sleeping preschool children in care, along with 4 Teachers. LPA also observed 3 clerical staff in the front of the office. Ramona Perez, Interim Site Director came shortly after.

During the inspection, LPA informed Ramona Perez, the results provided from SWRCB, indicated the facility had elevated levels of lead in the water drinking fountain near the entrance door of the facility. The Department was notified of the Action Level Exceedance (ALE), levels for the preschool drinking fountain (Sample C) 14.0 UG/L. The SWRCB report sample listed facility inspected and collected sample on 01/14/23. Results were provided to facility on 02/10/23. Lab Job Number: 01051

LPA Tamayo has received required documents within the required timeframe.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YWCA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191290314
VISIT DATE: 02/17/2023
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LPA advised Interim Director, all water outlets tested with an ALE at the facility should be placed as out of service.

Per Director, sample C near the front entrance door has never been used. The facility uses filtered water through the Company Pure Life, with disposable cups. Director has covered affected drinking fountain and taped for inaccessibility to children present. Director has also posted a sign on the drinking fountain.

The drinking fountain will be replaced and retested.

Once the repairs are made, Director will retest water for lead and notify LPA Tamayo of results after 3 weeks (21 day). Director is aware the lead levels shall not exceed 5.00 UG/L

No deficiencies will be cited at this time.

An exit interview was conducted and a copy of this report was provided, along with a Notice of Site Visit and appeal rights to Interim Director Ramona Perez..

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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