147750003-4-13-2026-12-CC-CALI-DT4RY9-20260413132559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 147750003
Report Date: 04/13/2026
Date Signed: 04/13/2026 01:26:35 PM

Document Has Been Signed on 04/13/2026 01:26 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:	ICOE-LONE PINE STATE PRESCHOOL		FACILITY NUMBER:	147750003
ADMINISTRATOR/ DIRECTOR:	KATHLEEN DUNCAN		FACILITY TYPE:	850
ADDRESS:	283 E LOCUST ST		TELEPHONE:	(760) 873-5123
CITY:	LONE PINE	STATE: CA	ZIP CODE:	93545
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 7	DATE:	04/13/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:11 AM
MET WITH:	Paige Martinez, Director/Teacher		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 13, 2025, Licensing Program Analyst (LPA) Crystal Ali arrived at the facility to conduct an Annual Random Inspection. LPA was met by Director/Teacher and permitted to enter the facility. LPA toured the facility in accordance with the facility sketch with Director. During the inspection, LPA observed 7 preschool child, 2 teacher aides, 1 Teacher/Director, providing care and supervision. Facility operates Monday through Friday from 7:45am to 4:15pm. LPA observed current LIC 9040 and LIC 500. Currently there are 8 children enrolled. Staffing Ration and Capacity: LPA observed all staff have approved background check clearances through Guardian. Facility consists of one large classroom (two child bathrooms), one staff office, one full staff bathroom, kitchen, two storage closets, two large storage areas with cabinets, and one outdoor play area. Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met. Director informed LPA that there are no weapons, no smoking, and no bodies of water on the premises. Physical Plant: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed sign-in sheets completed by each parent/guardian on paper document at the front door entrance.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 8

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)

Page: 2 of 8

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: ICOE-LONE PINE STATE PRESCHOOL	FACILITY NUMBER: 147750003
	VISIT DATE: 04/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed individual storage for children's belongings in each classroom. The children have access to tap water via water fountain at the back of the classroom. Staff assist children with filling up their water bottles at the kitchen sink. First Aid Kits are complete and in located in the kitchen area inaccessible to children. There are three first aid kits on table and AED machine on the wall next to fire extinguisher. Trash cans with tight-fitted lids were observed. Off-limit areas are the kitchen, staff bathroom, and staff office.
Napping: Children are provided napping daily from 12:30pm-2:30pm. Children are provided cots to sleep on during nap time. Each child has their own cots for napping. Napping materials are provided by the preschool. If children have an accident, then facility will wash their napping materials right away. There is laundry area on the premises inaccessible to children in the storage room.
Kitchen: The kitchen is inaccessible to children. There is a clean, fully equipped kitchen with a refrigerator, freezer, oven, ice machine, toast over, stove, and microwave. The facility provides breakfast, lunch, and afternoon snacks to the children. Allergy lists are posted in the kitchen, in child record file, and in the classroom. There are no children with food allergies. LPA observed an appropriate number of snacks and staff preparing snacks (with gloves). LPA observed lunch time. Chemicals, soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies and located above stove and in the laundry room inaccessible to children. The knives are located in the cabinets above the microwave inaccessible to children. LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Menus are posted at least one week in advance and made available for review by the parents. The facility does participate in the food program for lunch only.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 3 of 8

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: ICOE-LONE PINE STATE PRESCHOOL	FACILITY NUMBER: 147750003
	VISIT DATE: 04/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Daily activity schedules are posted showing meals/snack times, and specific activities. As you walk down the hallway your will see the staff bathroom to the left and two closets to the right and staff office straight ahead.
Fire Extinguisher: Emergency Drills are conducted at least every six months, and the last drills were conducted and documented on 3/24/26. There are three fire extinguishers throughout the facility all reading in green and meet the Fire Marshall Codes and Standards (last checked 11/20/25). Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition per Fire Marshall standards. Director stated that she is unaware of when the fire marshall has come to the facility last.
Bathroom: Age-appropriate sinks and toilets were inspected for availability and good repair. Each bathroom in the classroom has 1 sink and 1 toilet. LPA observed diaper changing station in bathroom #2. Off limit area has a staff bathroom in the kitchen hallway to the right. It has a shower, 1 sink, and 1 toilet. Each restroom has adequate toilet paper, diapers, pull ups, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff.
Medication: A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The teachers pass out medication. Medication is labeled correctly and stored in its original container locked in the laundry room area inaccessible to children. There currently are no children on medication. LPA observed the required documentation for passing and storing this child medication. Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. Isolation area is under the loft area where staff can provide 100% supervision until the parent arrives to pick them up.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 4 of 8

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: ICOE-LONE PINE STATE PRESCHOOL	FACILITY NUMBER: 147750003
	VISIT DATE: 04/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Transportation: The facility does not provide transportation for the children.
Lead Testing/Drinking Water: The facility has had lead testing completed and passed on 4/5/23. Copy of lead water testing results are in the facility file.
Outdoor Activity Space: The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Play yard is located in the back of the preschool. Teachers walk the children over to the play yard. Play yard has a large play equipment (anchored with 3 slides and shaded). There is tricycle track, one sandbox, and a four-swing set, a locked shed inaccessible to children, and several other outdoor toys. Children are provided tap water via individual water bottles. There are adequate shaded areas (2 small in play equipment) for rest. LPA recommends a larger shade area for children and staff. The playground is well-fenced, all around and no bodies of water were observed in the outdoor play area. Maintenance from the school landscapers come weekly and teachers are to clean debris daily in morning. The teachers will continue to provide 100% supervision when outside in the playground.
Records/Documentation: LPA reviewed with facility representative the LIC 125, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. LPA observed the staff file of SPED teacher aide that is assigned to a child as a one on one through Inyo County School District. The teacher aide comes only when the child is present. Staff records (3) are incompliance. Child records (3) are in compliance.

No deficiencies cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 5 of 8

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: ICOE-LONE PINE STATE PRESCHOOL	FACILITY NUMBER: 147750003
	VISIT DATE: 04/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

A notice of site visit was given and must remain posted for 30 days. A copy of this report and copy of appeal rights were provided to facility representative.

Exit interview conducted and report was reviewed with the Director/Teacher, Paige Martinez.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Criminal Record Clearance - Child Care Centers
Facility representative was reminded that all adults 18 and over, including
employees and volunteers, except as specified in Health and Safety Code section 1596.871,
must obtain a criminal record clearance or exemption, or transfer their existing clearance or
exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00
minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a
maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 6 of 8

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: ICOE-LONE PINE STATE PRESCHOOL	FACILITY NUMBER: 147750003
	VISIT DATE: 04/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Lead Testing – Child Care Centers (CCC)
CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility
of the importance of checking for recalled infant devices on the United States
Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Incidental Medical Services (IMS) - Child Care Centers
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: ICOE-LONE PINE STATE PRESCHOOL	FACILITY NUMBER: 147750003
	VISIT DATE: 04/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
PIN 22-05-CCP
MyChildCarePlan.org – Child Care Centers
Facility representative was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Subscribe to CCLD important information - Child Care Centers
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 8 of 8