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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402211
Report Date: 12/10/2025
Date Signed: 12/10/2025 04:03:38 PM

Document Has Been Signed on 12/10/2025 04:03 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:FIRST UNITED METHODIST PRESCHOOLFACILITY NUMBER:
197402211
ADMINISTRATOR/
DIRECTOR:		SANDRA CLEMONSFACILITY TYPE:
850
ADDRESS:39055 10TH STREET WESTTELEPHONE:
(661) 272-1334
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 15DATE:
12/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Sandra Clemons, DirectorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On December 10, 2025, Licensing Program Analyst (LPA) Annelise Villa met with Director Sandra Clemons, who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident inspection regarding an incident that occurred on December 3, 2025. This Unusual Incident was self-reported on December 4, 2025. LPA discussed reporting requirements, pursuant to California Code of Regulations (CCR) Title 22, Section 101212(d), to ensure all reportable unusual incidents are reported within specified time frames. Upon arrival LPA observed 15, along with 5 staff including the director caring for them.

Description of incident: On December 3, 2025, at approximately 12:58 pm, 2 daycare children were observed by director via video camera Staff #2 counted their classroom and went back inside once all children were accounted for. The children were left unattended from 12:41 pm to 12:58 pm. Director interviewed Staff #1 and confirmed no head count was conducted before taking the children inside, per facility policy. Director saw Child #1 and #2 alone on the playground and immediately called the nearest teacher to collect the children and return them to their classroom. Upon review of video footage, the children were left unattended outside for 17 minutes. Director interviewed all staff who were outside during playtime. Director dismissed Staff #1 effective 12/3/2025. Children were interviewed by staff and unharmed. Parent meetings were held on 12/5/2025 for viewing of the footage and to discuss any concerns.

During this visit, LPA reviewed video footage, conducted interviews with staff, and collected relevant documents. As a result, the center was found in violation of Title 22, Section 101229(a)(1), No child(ren) shall be left without the supervision of a teacher at any time. This is a Type A deficiency, please see LIC 809-D for details.

Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211
VISIT DATE: 12/10/2025
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Upon Receipt of a Type A deficiency, Director shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Direcotr was advised LIC 9224 shall be kept in children's file.

The Notice of Site Visit was provided, and LPA observed posting. Licensee is advised it must remain posted for 30 days.  An exit interview was conducted, A copy of this report and Appeal Rights were discussed and provided. Signature at the bottom of this report confirms receipt. 

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/10/2025 04:03 PM - It Cannot Be Edited


Created By: Annelise Villa On 12/10/2025 at 03:18 PM
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: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
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Staff will participate in training on care and supervision and send proof of completion to LPA Villa no later than 12/17/2025.
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Based on interview and record review, Child #1 and Child #2 were left unattended and unupervised in the playground for 17 minutes. This is an immediate health, safety, or personal rights risk to the persons 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.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Annelise Villa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2025


LIC809 (FAS) - (06/04)
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