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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411755
Report Date: 09/08/2025
Date Signed: 09/08/2025 01:50:35 PM

Document Has Been Signed on 09/08/2025 01:50 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CANYON SPRINGS 2-SULPHUR SPRINGS SCHOOL DISTRICTFACILITY NUMBER:
197411755
ADMINISTRATOR/
DIRECTOR:		EDNA RODRIGUEZFACILITY TYPE:
850
ADDRESS:19059 VICCI STREET #50TELEPHONE:
(661) 252-8045
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 19DATE:
09/08/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:12 PM
MET WITH:Edna RodriguezTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On September 8, 2025, Licensing Program Analyst (LPA) Calloway, conducted a case management inspection for the purposes of responding to lead exceedance at the facility. LPA met with facility representative was granted access and toured the facility with the representative. LPA observed nineteen (19)-day care children and four staff in care. The water lead testing results were received from Forensic Analytical Consulting Services (FACS) for a lead water test that was conducted on June 11, 2022.

LPA toured the facility and observed the water fountain faucet (B) according to facility sketch and observed water fountain in the outside play area next to Classroom #49.

LPA reviewed the report findings to which there was an exceedance in (B) water fountain at or above the 5-ppb identified and a potential localized source of lead contamination at the fixture for the Drinking fountain outside the classroom identified as Sample B. During the inspection, the representative stated children drink from the water fountain. On 06/29/2022, the facility received information for a plan of correction to have:

1. The outlet removed from service and drinking immediately ceased.

2. Notification provided, and testing results were posted at the facility June 30, 2022.

3. Alternative drinking water sources provided: Other sinks or fountains, bottled water.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CANYON SPRINGS 2-SULPHUR SPRINGS SCHOOL DISTRICT
FACILITY NUMBER: 197411755
VISIT DATE: 09/08/2025
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4. Replacement of fixtures. The identified fixture will be replaced on July 11, 2022

5. Fixture conditioning- the new fixture will be turned on for at least 30 seconds and least 4 times a day for at least 3 weeks prior to follow up sampling (B) the flushing process will be tracked on a sheet posted next to the new outlet.

6. Follow up testing- Per AB 2370, outlets that have been replaced as part of the Plan of Correction will be sampled by a certified third-party sampler at least three weeks after fixture replacement. (B) follow up testing was scheduled for August 10, 2022. (C) Parents/guardians will be notified upon receipt of follow up testing 1-2 weeks from follow up sampling.

LPA observed individual drinking water bottles in the classrooms at the facility. Representative stated the personal water bottles are returned daily.

Representative stated the facility has followed proper procedures and ensured safety for water fountain (B) by adhering to the plan of corrections. Representative stated PUB 515 was posted during that time in a prominent area of the day care center.

Therefore, are no deficiencies cited during this inspection. There is a Technical Violation issued. See TV page attached to this report.

An exit interview was conducted, a copy of this report, a Notice of Site Visit (LIC 9213) was provided to Edna Rodriguez, the facility representative during this inspection. The Notice of Site must remain posted for thirty (30) consecutive days. Removal of the posting will result in a $100 civil penalty.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC809 (FAS) - (06/04)
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