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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290314
Report Date: 11/28/2023
Date Signed: 11/28/2023 11:58:01 AM

Document Has Been Signed on 11/28/2023 11:58 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: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: 65DATE:
11/28/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Ramona Perez, Site DirectorTIME COMPLETED:
12:15 PM
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On 11/28/23, Licensing Program Analysts (LPAs) Evelyn Garcia and Isabel Ortega conducted a Case Management inspection in response to a Unusual Incident Report (UIR) received on 10/24/23. LPA Garcia and Ortega met with interim director, Ramona Perez . The purpose of the inspection was disclosed, and entry was granted. Upon arrival LPAs observed 65 children in care, along with 17 staff present including office staff and director.

During the inspection, LPAs interviewed the director regarding the UIR received and clarified that the report submitted was in response from emails that facility kept receiving from a water lead testing company stating lead tested must be completed to stay in compliance. This is the reason facility submitted the UIR.

LPA informed director, 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

LPAs have received required documents within the required time frame and observed the plan of correction (POC) to be in place.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YWCA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191290314
VISIT DATE: 11/28/2023
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LPAs advised Interim Director, to continue to keep the water fountain in the facility 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 with a box and taped for inaccessibility to children present and was observed by LPAs Garcia and Ortega. Director has also posted a sign on the drinking fountain.

The director stated that the drinking fountain continues to be inaccessible and will not be removed at this time.

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: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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