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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403512
Report Date: 01/25/2023
Date Signed: 01/25/2023 12:19:57 PM

Document Has Been Signed on 01/25/2023 12:19 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:KINDERCARE LEARNING CENTERFACILITY NUMBER:
197403512
ADMINISTRATOR:ILIANA FARALDOFACILITY TYPE:
840
ADDRESS:18525 W. SOLEDADTELEPHONE:
(661) 251-9176
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 0DATE:
01/25/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Paige MartinezTIME COMPLETED:
11:00 AM
NARRATIVE
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On 1/25/2023 Licensing Program Analyst LPA) Isabel Ortega conducted an unannounced case management inspection. LPA Ortega met with Director Paige Martinez. The purpose of today's inspection is to conduct a Case Management inspection regarding water sample results and to notify facility there has been a lead exceedance referred for an Action Level Exceedance (ALE) 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 water fountain (H) located in the classroom drinking fountain has an ALE of 16.0 ppb. The water fountain(H) was being utilized as optional drinking water on rare occasions. According to facility last date of water usage for drinking by children was on 12/27/2022.

Director has made the water fountain (H) inaccessible until fountain is replaced or permanently shut off. Filtered water is available to school age children, LPA Ortega observed 5 gallon water bottles at the facility. A water pitcher with filtered drinking water and disposable cups or personal individual bottles are available for children during day care hours(see plan of correction for further corrective action 809D). The facility has notified authorized children's representatives about the water sample results and corrective plan.

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). Director was provided a copy of the appeal rights. An exit interview was conducted. Copy of this report, Notice of site visit(required to be posted for 30 days) and appeal rights have been provided on this day. This report shall be made available to the public upon request.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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 01/25/2023 12:19 PM - It Cannot Be Edited


Created By: Isabel Ortega On 01/25/2023 at 11:25 AM
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: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 197403512

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2023
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. (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole 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. (c) If testing indicates an Action Level Exceedance 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
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Facility has made an order request to replace the water fountain fixtures and retest. In the meantime Facility has made fountains inaccessible until results are under 5.5ppb. Facility will submit results to the Palmdale RO by email by 2/22/2023.
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This requirement was not met evidence by results from water sample on 12/20/22 indicating the water fountain (H) in the school age classroom had a ALE of 16.0 ppb 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 King
LICENSING EVALUATOR NAME:Isabel Ortega
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023


LIC809 (FAS) - (06/04)
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