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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750002
Report Date: 06/12/2024
Date Signed: 06/12/2024 05:10:59 PM


Document Has Been Signed on 06/12/2024 05:10 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:OAK TREE LEARNING CENTERFACILITY NUMBER:
367750002
ADMINISTRATOR:CARTER, JENNIFERFACILITY TYPE:
840
ADDRESS:680 W. 40TH STREETTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:48CENSUS: 14DATE:
06/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:06 PM
MET WITH:Melissa DavisTIME COMPLETED:
05:30 PM
NARRATIVE
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On 06/12/2024 Licensing Program Analyst (LPA) Babatunde Ibitoye arrived at the facility for the purpose of conducting an initial complaint investigation which was received at the Palmdale Regional office on 06/05/2024. LPA met with Director Melissa Davis and informed the purpose of the inspection and was granted entry. During today’s inspection a tour of the area where daycare services are provided was conducted, LPA observed a total of 14 school age children in care and (1) staff.

During this investigation, LPA interviewed Director and Review C#1 file. The Facility was unable to provide the facility roster upon request. This is violation of Health and Safety Code Section 1596.841 See LIC 809D For deficiency cited.

An exit interview was conducted, and a copy of this report has been signed by and provided to the Director Melissa Davis, Notice of Site Visit and Appeal Rights were given.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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 06/12/2024 05:10 PM - It Cannot Be Edited

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: OAK TREE LEARNING CENTER
FACILITY NUMBER: 367750002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2024
Section Cited
HSC
1596.841

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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Per Director the facility unable to obtained facility roster due to facility switch from ProCare to bright wheel app. Director requested a copy from ProCare and will email the roster to LPA by due date.
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Based on observation/interview/record review, the Facility did not comply with the section cited above. which poses a potiential health and safety to 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: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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