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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750170
Report Date: 01/14/2025
Date Signed: 01/14/2025 01:23:29 PM

Document Has Been Signed on 01/14/2025 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CCRC 10TH STREET HEAD STARTFACILITY NUMBER:
197750170
ADMINISTRATOR/
DIRECTOR:		BEATRIZ ZAMORANO-PEDREGONFACILITY TYPE:
850
ADDRESS:44236 10TH ST WESTTELEPHONE:
(661) 494-7999
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 56DATE:
01/14/2025
TYPE OF VISIT:Case Management - Infectious Disease OutbreakUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Lead Teacher Jasmine RuizTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 1/14/2025, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by the Facility Representative who permitted entry to the facility. LPA toured the facility with the Lead Teacher Jasmine Ruiz according to the facility sketch. Upon arrival, LPA observed 56 children present with 8 staff members providing care and supervision; the Lead Teacher stated that each classroom had additional staff present but were currently on break during the walk through. LPA observed that the facility was within ratio in each classroom.

During this inspection, LPA conducted a followed up on the report of an outbreak that was received on 10/14/2024 as reported by the Supervisor. LPA conducted interviews with relevant parties regarding the incident, reviewed records, and made observations during the incident. The investigation revealed the following information:

There was a report from the facility’s management to the Community Care Licensing Division (CCLD) on October 14th, 2024 of an outbreak of an unknown disease affecting multiple preschoolers which was reported by the Supervisor. The facility’s management was made aware of the children showing signs of an unknown illness by the parents of impacted children starting on October 7th, 2024 and being reportable no later than October 9th, 2024. The facility’s management notified the local health officer, the Department of Public Health, of an unknown outbreak impacting children on October 11th, 2024, days after the outbreak began at the facility as confirmed by the Public Health Nurse. The facility’s management was made aware of the children showing signs of an unknown illness by the parents of impacted children and should have reported to CCLD no later than October 9th, 2024 and should have reported by telephone to local health officer immediately on October 8th, 2024. The outbreak consisted of multiple children showing signs of illness including vomiting, diarrhea, fever, rash, lethargy, stomach upset, and stomach ache.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 01/14/2025
NARRATIVE
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The facility experienced an ongoing outbreak of infection, including recurrent infections, impacting multiple children showing the signs of illness previously aforementioned. The facility’s management did not meet reporting requirements by not reporting to the CCLD of an outbreak of any disease within the next working day during normal business hours once they became aware of two or more children showing signs of illness and they did not report the outbreak of any disease involving two or more children to the local health officer immediately by telephone.

Once the facility received instructions from the Department of Public Health, they followed the directions provided to them and the outbreak precautions were put into effect at the facility. This is a violation of reporting requirements and is a Type B violation, see the LIC 809D for the details.

Currently, the outbreak is under control with following the guidelines set by the Department of Public Health and as a result, the outbreak has been closed by the Department of Public Health.

All licensing reports are recommended to be kept for 3 years.

An exit interview was conducted, and a copy of this report was read and provided to the Lead Teacher along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/14/2025 01:23 PM - It Cannot Be Edited


Created By: Andrea Pittman On 01/14/2025 at 11:52 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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/28/2025
Section Cited
CCR
101212(d)

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101212 Reporting Requirements
(d) ...during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. This requirement was not met as evidenced by:
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Lead Teacher states that they will create a plan to meet reporting requirements and send via e-mail no later than 1/28/2025.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above by not reporting an outbreak of unknown disease affecting two or more children by the next working day during normal business hours to CCLD which poses a potential health, safety, or personal rights risk to persons in care.
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Type B
01/28/2025
Section Cited
CCR101212(g)(1)(2)(A)

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101212 Reporting Requirements (g)The licensee shall report to the local health officer all outbreaks or suspected outbreaks involving two or more children of any communicable disease listed in (g)(2)(A) below...OUTBREAKS of ANY DISEASE (Including diseases not listed in Section 2500). ...to be reported immediately by telephone. This requirement was not met as evidenced by:
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Lead Teacher states that they will create a plan to meet reporting requirements and send via e-mail no later than 1/28/2025.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above by not reporting an outbreak of unknown disease affecting two or more children immediately by phone to the local health officer which poses a potential health, safety, or personal rights risk to 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.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


LIC809 (FAS) - (06/04)
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