197750041-9-10-2025-12-CC-JTAO-DLDTER-20250910144022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750041
Report Date: 09/10/2025
Date Signed: 09/10/2025 02:40:34 PM

Document Has Been Signed on 09/10/2025 02:40 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:	PSD ECE MANZANITA CENTER		FACILITY NUMBER:	197750041
ADMINISTRATOR/ DIRECTOR:	DR. MELANIE CULVER		FACILITY TYPE:	850
ADDRESS:	38620 33RD STREET EAST		TELEPHONE:	(661) 266-7804
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 40	CENSUS: 0	DATE:	09/10/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:11 PM
MET WITH:	Joe Vega-Smith, School Readiness Coordinator		TIME VISIT/ INSPECTION COMPLETED:	02:59 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 8/28/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with the School Readiness Coordinator (SRC), Joe Vega-Smith, for the purpose of conducting an unannounced Annual/Random inspection. This Head Start Program is held on the grounds of Manzanita Elementary School. LPA toured and inspected the preschool in accordance with the facility sketch. This Head Start Program will occupy 2 classrooms (Rm A and B). The Center will operate 2 full-day classrooms Monday through Friday from 7:30 am to 4:30 pm and will cater to children ages 2 yrs. to 5 yrs. Upon arrival, LPA observed 2 classrooms in use with a total of 0 preschool children and 2 teachers and 5 assistants on the premises. Incidental Medical Services (IMS) were discussed. Physical Plant: LPA toured and inspected the preschool classrooms. Furniture and equipment were checked for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings labeled with their names. LPA observed age-appropriate toys and materials. Daily activities schedule was observed in each classroom. LPA observed a sufficient quantity of mats available for napping children. Children nap on mats; bedding and linens will be stored in cubbies; lunches will be delivered from the cafeteria. weekly (sent home with parents to wash or staff wash after hours), and cots are sanitized daily. Drinking water is available inside the classrooms in the form of disposable plastic cups and water jugs. There are fire alarms and carbon monoxide detectors located by the doors of each classroom in operable condition.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Justeene Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

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 6

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 6

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: PSD ECE MANZANITA CENTER	FACILITY NUMBER: 197750041
	VISIT DATE: 09/10/2025

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

The play area was inspected and found to be free of hazards—separate playground schedule for school-age and preschool children. The jungle gym is anchored. There is a bike path, jungle gym, and other age-appropriate toys.
Sign-in and out sheets were reviewed. The facility uses a digital sign-in sheet and paper sign – in sheet. The Teacher-to-child ratio was observed, and staff names were recorded. Care and supervision were evaluated to determine if the basic needs of children were met and appropriate.
Staff Records/ Children Records: Staff and Children's records were reviewed. LPA verified there is at least 1 staff person present with current CPR and First Aid Training, which expires on 02/28/2027. Mandated Reporter training expires 09/03/2026. All staff receives Measles, Pertussis, and Influenza vaccination. All staff have required fingerprinting associated with the facility.

LPA reviewed 10 children's records, complete with the parent’s signature.
Food Service: There is a clean, fully equipped kitchen (off-limits) with a refrigerator, freezer (1), and microwave oven. Allergy lists are posted in the classroom. The facility provides breakfast, lunch and two snacks. Menus are posted in the office in each classroom. LPA observed an appropriate amount of food and snacks. Cleaning solutions and other chemicals are kept in a cabinet above the sink with the lock-in classroom and the main building's maintenance room. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Justeene Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: PSD ECE MANZANITA CENTER	FACILITY NUMBER: 197750041
	VISIT DATE: 09/10/2025

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

Fire extinguishers are maintained in operable condition.
All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on; they shall be leakproof and rodent-proof.

LPA inspected and observed two clean bathrooms. The toilets and sinks function properly and are age-appropriate. The water temperature is appropriate. LPA observed soap, toilet paper, and paper towels readily available. There were 4 sinks, 5 toilets, and 1 urinal for the child care bathroom.

Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The on site nurse must administer medication and document the dosage, date, and time on a log. Medication is brought and locked at the center (unless the parent requests daily return). Medication is labeled correctly and stored in its original container. Medication is kept at the center until expiration and sent home with the parent for disposal. There are currently no children who needs IMS at this time. The staff office has a separate area for isolating and caring for ill children. There is a mat available for ill children. An isolated toilet and sink are available for ill children in the staff restroom.

A Fire Drill/Earthquake log is posted in the office. The center conducted disaster drills for at least 6 months (08/27/2025). A current Roster is available. LPA observed a fully stocked first aid kit.

The outdoor: The outdoor play equipment was inspected for health, safety, cushioning material, good repair, and age appropriateness. The play area has sand and concrete. There is an area for rest (canopy). A water pitcher and disposable cups are brought outside during play.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Justeene Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: PSD ECE MANZANITA CENTER	FACILITY NUMBER: 197750041
	VISIT DATE: 09/10/2025

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

The following general information was discussed during this inspection:
· For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Center does not provide IMS at this time.
· As of January 1, 2018, childcare providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training provided according to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
· §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a daycare center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
· All Licensing reports are available for review online and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Justeene Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: PSD ECE MANZANITA CENTER	FACILITY NUMBER: 197750041
	VISIT DATE: 09/10/2025

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

· School Readiness Coodinator advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit a written report within 7 days) and on the form LIC624. The Center reminded to review updates/regulations and quarterly updates on the Department website. The "Notification of Parent's Rights" poster must be posted in an area of the center accessible to parents. The information regarding new legislation about exemptions and Parent’s Rights was also discussed.

No deficiency was cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

Exit interview conducted and the report was reviewed with the with School Readiness Coordinator, Joe Vega-Smith.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Justeene Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC809 (FAS) - (06/04)

Page: 6 of 6