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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417396
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:09:28 PM

Document Has Been Signed on 05/12/2023 03:09 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:MONTESSORI OF VALENCIAFACILITY NUMBER:
197417396
ADMINISTRATOR:ERIN JOHNSONFACILITY TYPE:
850
ADDRESS:24925 ANZA DRIVETELEPHONE:
(661) 257-4161
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 138TOTAL ENROLLED CHILDREN: 138CENSUS: 16DATE:
05/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Erin JohnsonTIME COMPLETED:
03:30 PM
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On 5/12/2023 Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced case management -Lead Exceedance inspection. LPA Ortega met with Director Erin Johnson and toured the facility according to the facility sketch. The purpose of today's inspection is to conduct a case management inspection regarding lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 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 water sample, tested on 4/14/2023. The water lead sampling test results are based on the Enthalpy analytical test report results in water fountain "E" located in the second outdoor playground. This drinking fountain "E" results reported an ALE of 42 ppb, this is exceeding an ALE water of over 5.5 ppb.

Facility's labeled "E" (according to the facility sketch) drinking fountain is out of service and valve is shut off, according to facility children do not have access to the fountain. This is an infant area and children are provided with bottles and/or personal individual cups brought from home. Bottles and/or cups are filled with a filtered water dispenser and transported in an igloo for outdoor drinking water. According to facility water fountain "E" has not been used by children at day care for drinking nor food preparation. Filter water under 5.5 ppb is readily available for children during hours of operation.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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: MONTESSORI OF VALENCIA
FACILITY NUMBER: 197417396
VISIT DATE: 05/12/2023
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations. According to interview conducted drinking fountain "E" was sampled and included due to instruction to label ALL fountains even if not in use by sampler. Facility will not be cited and facility will continue to provide children with filtered water from a dispenser. An exit interview was provided, facility was provided with a copy of this report, appeal rights and notice of site visit (NOA).

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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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