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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750152
Report Date: 08/06/2026
Date Signed: 08/06/2026 01:23:10 PM

Document Has Been Signed on 08/06/2026 01:23 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:CALIFORNIA CHILDREN'S ACADEMYFACILITY NUMBER:
197750152
ADMINISTRATOR/
DIRECTOR:		AURA OSOYFACILITY TYPE:
830
ADDRESS:10896 LEHIGH AVENUETELEPHONE:
(323) 223-3312
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
08/06/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:42 AM
MET WITH:Kimberly Gonzalezj.TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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On August 5, 2026, at 9:42 AM., Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility for the purpose of conducting an Annual Random inspection. LPA met with Kimberly Gonzalez, facility representative who granted access. At 9:45 AM., LPA and representative toured the facility inside and outside. LPA observed fifteen (15) infant day care children in active play and seven staff. There are three small infants and eighteen walking infants enrolled. The staff/child ratios were observed to be compliant. The facility is open from 6:30 AM to 5:30 PM, Monday through Friday. All employees 18 years or older that are working or volunteering have a Criminal Record Clearance and are associated with the facility. At 10:30 AM., Ruth Aleman, site coordinator, arrived on site.
Physical Plant: The parent wall was in a prominent location near the front entrance with the required postings. The sign in/out sheets were paper and legible. There is one large clean and safe classroom, the telephone service, heating, ventilation, and lighting are adequate. The staff wear booties inside the facility and replace them before coming inside from outside play. The daily schedule, and activities were posted inside the classroom. There are cubbies for children's belongings that are labeled with their names, and the furniture, books, equipment, toys, and materials were appropriately aged, in good condition, and at the appropriate height. There were activity rugs inside the classroom for play that are cleaned daily and the representative stated the rugs are deep cleaned once a month. The drinking water is available inside the classrooms in the form of a water igloo and disposable cups.
Francisco Pedroza
Kuliema Calloway
DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2026
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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Document Has Been Signed on 08/06/2026 01:23 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 08/06/2026 at 12:28 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.841
§1596.841 Current roster of children provided care in facility required

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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation interview record review, the licensee did not comply with the section cited above in the facility did not have a child/parent roster created during the inspeciton which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/03/2026
Plan of Correction
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I will complete the roster as soon as possible and provide proof to Licensing by the POC date,
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Francisco Pedroza
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


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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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 08/06/2026
NARRATIVE
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There were mats for napping equipment and there was enough for all the children. The representative stated they provide a fitted sheet and no blankets. LPA observed a separate napping room for smaller infants with six cribs and a diaper changing table with a sink nearby that had soap and paper towels available. The staff sanitize the changing table after each use. There was a small refrigerator at the appropriate temperature with labels inside for the infants’ bottles. The first aid kits were inside the classroom in a red backpack. The representative stated there is an emergency survival kit kept in backpacks in the infant room. The trash cans were observed with secure lids, and the temperature inside the room was comfortable. Representative stated the fire extinguishers, smoke detectors and carbon monoxide detectors throughout the day care center are all operable and were checked during the last fire inspection. There is no restroom, the children are all wearing diapers and the facility provides diapers and wipes; the parents supply creams as needed. LPA observed the forms signed in the children’s files for authorization. The staff restrooms are in the hallway outside of the classroom. There is a fully equipped kitchen with refrigerator, freezer, stove, oven, microwave, and double sink. The kitchen was clean and there were no accessible hazards observed. The facility provides breakfast, lunch, and afternoon snacks and the menus are posted inside the class. There is a confidential allergy list posted in the kitchen and the LPA observed an appropriate amount of food and snacks. The staff’s food items were in a separate refrigerator in a staff designated area. The chemicals and cleaning supplies are kept separate from the food and are kept in a storage room.

Outside: Outdoor play equipment was inspected for safety, cushioning material, good repair and is age appropriate and at the right height. LPA observed a separate play area for the small infants with a canopy for shade and a rubber mat as a cushioned surface. There is concrete, rubber mats, and grass area for active play. There was a stand-up sandpit, crawl tunnel, tables/chairs, bike cars, and a play house. The playground was observed to be free of debris, and the drinking water is available in the form of a portable water jug and disposable water cups. The representative stated there are no large bodies of water on the premises; LPA did observe small wading pools with water and staff providing supervision and a large water table that was empty. There was a diaper changing table and a handwashing sink. The fencing is chain-linked with the privacy screen and was observed locked and is secure around the entire playground.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 08/06/2026
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Other Review: Children and staff files were reviewed. The napping logs and Infant sleep plans (LIC 9227) forms were reviewed and the needs and services plans. Current Pediatric CPR/First Aid (expires: 6/2027). Representative stated transportation is not provided. Disaster Drills: the fire drill was conducted 7/6/2026 and earthquake drill were conducted: 7/13/ 2026. The representative stated the last facility fire inspection was conducted: July 2026. The child/parent roster was not available during this inspection. The representative stated they did not know it was required. The representative stated the children are inspected for illnesses as they arrive. There is not a separate isolation area for ill children but if children are sick the staff remains with the child until the parent can pick up the child. The representative stated that medication is not provided to any of the children at this time. They are aware prescription medication should be administered in accordance with the label directions as prescribed by the child's physician. For each prescription and non-prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child and inform their representative when medication was given. Each container shall have an unaltered label. The representative stated a water/lead test was conducted in June 2026. At 11:00 AM., LPA reviewed and discussed the regulations with the representative. The representative stated they are aware of the reason for the deficiency being cited. LIC 125 form was discussed with the representative.


The following was discussed with the Representative:
Representatives are aware the childcare center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors and the department has the right to inspect. Access the CCLD Licensing website at www.ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates. Report any director or staff changes within ten (10) days. All employees are responsible for knowing the regulations when providing care. All employees should know their role and responsibilities of being a mandated reporter. Training is renewed every two years at: mandatedreporterca.com. All adults 18 years and
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 08/06/2026
NARRATIVE
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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.

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 Questions about Child Care
Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers that were constructed before January 1, 2010, to test their water (used for
drinking and food for lead contamination before January 1, 2023, and then every 5 years after the date of the first test. For childcare 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). Or LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600. Review PUB 515 for information and posting. 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 representative of the importance of checking
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 08/06/2026
NARRATIVE
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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. State law prohibits baby walkers, bouncy seats, exersaucers, bassinettes or any other items that fall into that category. All infants are sleeping on their backs unless specified with LIC 9227 form and no blankets, toys, or pacifiers attached. Conduct 15-minute nap monitoring and a napping log is kept daily for each infant.

Facility representative was informed of the MyChildCarePlan.org website, a
consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

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.

Reminder: The CCLD On Duty Worker is available: Monday through Friday from 8:00 AM - 5:00 PM, at (661) 202-3318 for questions, information, and unusual incident reporting.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 08/06/2026
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 Once the incident is reported within twenty-four (24) hours via telephone, follow up with a written report (LIC 624 form) via email to unusualincidentreport@dss.ca.gov or via fax (661) 202-3810 within seven days of reporting.

There is one Type B deficiency cited during this inspection per HSC, and one Technical Violation issued. See LIC 809D and LIC 9102 TV page attached to this report.

An exit interview was conducted, a copy of this report was read, a Notice of Site Visit (LIC 9213), this report, and Appeal Rights were given to Ruth Aleman, facility representative at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting may result in a $100 civil penalty.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC809 (FAS) - (06/04)
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