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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492871
Report Date: 09/07/2022
Date Signed: 09/07/2022 11:41:39 AM

Document Has Been Signed on 09/07/2022 11:41 AM - 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:LEARNING TREE PRESCHOOL, THEFACILITY NUMBER:
197492871
ADMINISTRATOR:CHAVEZ, MATTHEWFACILITY TYPE:
850
ADDRESS:43260 CHALLENGER WAYTELEPHONE:
(661) 942-8240
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 9DATE:
09/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Laura Van Antwerp Site SupervisorTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) King-Lewis and Alemoh arrived at the facility to conduct a Case Management visit into a self reported Unusual Incident Report received by Community Care Licensing on 09/01/22. Upon today inspection LPAs observed 9 children being care for by 1 teacher in classroom C142. LPA met with Laura Van Antwerp Site Director and toured the room where the incident took place, interviewed staff member with knowledge of the incident.

From the information gathered the children were playing nicely at the table and when one of the children drop an item two of the children went to grab the item and bumped into each other which caused the injury. All three children playing at the table that witness the incident has graduated to kindergarten and no longer attends Learning tree preschool.

It was disclosed that at the time of the incident the teacher was caring for 13 children violating the teacher to child ratio regulation and a child receiving injuries during the time the of the violation.

This is a Type A violation. The Director is aware a copy of the licensing report (LIC809) and the Notice of Site Visit must be posted at the entrance of the facility
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LEARNING TREE PRESCHOOL, THE
FACILITY NUMBER: 197492871
VISIT DATE: 09/07/2022
NARRATIVE
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for a period of 30 days.

Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty

In addition; all parents/guardians of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and parents shall sign the LIC 9224 acknowledging receipt of licensing report.

An exit interview was conducted, appeal rights discussed, a copy of form LIC9224, Notice of Site Visit, and a copy of this report was provided to Site Director, Laura Van Antwerp on this date.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/07/2022 11:41 AM - It Cannot Be Edited


Created By: Lady King On 09/07/2022 at 11:18 AM
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: LEARNING TREE PRESCHOOL, THE
FACILITY NUMBER: 197492871

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/07/2022
Section Cited
CCR
101216.3(a)

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TEACHER/ CHILD RATIO
There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. This requirement was not met as evidenced by:
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Site Director stated the center will maintain a ratio of one teacher visually observing and supervising no more than 12 children in attendance. Director stated they are hiring a floater to be able to assist wherever needed.
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Based on interviews and the review of sign in/out sheets the facility failed to be in ratio on the while children were in care as one teacher was providing care and supervision for 13 children. This poses an immediate health and safety risk to children in care.
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 Site Director shall submit a plan of correction stating how the center will ensure teacher to child ratios are always maintained by no later than September 19, 2022

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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:Mariela Ramon
LICENSING EVALUATOR NAME:Lady King
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022


LIC809 (FAS) - (06/04)
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