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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750170
Report Date: 04/06/2026
Date Signed: 04/06/2026 03:13:35 PM

Document Has Been Signed on 04/06/2026 03:13 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:CCRC 10TH STREET HEAD STARTFACILITY NUMBER:
197750170
ADMINISTRATOR/
DIRECTOR:		ROCIO CARRILLOFACILITY TYPE:
850
ADDRESS:44236 10TH ST WESTTELEPHONE:
(661) 494-7999
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 47DATE:
04/06/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:23 AM
MET WITH:Jasmine Ruiz, Lead Teacher
(Designated Staff) 		TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On Monday, April 6, 2026, Licensing Program Analysts (LPAs) Mayra Rivera and Maria Avalos conducted an unannounced annual inspection and met with lead teacher Jasmine Ruiz who guided LPAs Rivera and Avalos on a tour of the facility. Annual fee is current.

This is preschool program that serves children ages 2 to 5 years. This program operates Monday to Friday 7:30 am to 3:30 pm. Sign in and out takes place at the main entrance area using a tablet. Teacher and child ratio were observed, and present staff are fingerprinted cleared and trained in pediatric first aid/CPR.



LPAs entered classroom 10. LPAs Rivera and Avalos observed 14 children napping with staff #1 and staff #2 present providing care and supervision. LPAs observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPAs observed cleaning solutions stored inside bottom sink cabinet locked with a key lock. LPAs observed a trash bin with a lid. LPsA observed children’s personal items inside their cubbies.

LPAs entered classroom 8. LPAs Rivera and Avalos observed 16 children getting ready for nap with staff # 3 and staff # 4, and staff # 5 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPAs observed cleaning solutions stored inside bottom sink cabinet locked with a key lock. LPAs observed a trash bin with a lid. LPAs observed children’s personal items inside their cubbies.

LPAs entered classroom 9. LPAs Rivera and Avalos observed 17 children getting ready for nap with staff #6 and staff #7 present providing care and supervision. LPAs observed age-appropriate furniture and equipment

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2026
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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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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/06/2026
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to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPAs observed cleaning solutions stored inside bottom sink cabinet locked with a key lock. LPAs observed a trash bin with a lid. LPAs observed children’s personal items inside their cubbies.

Heating, lighting and ventilation were evaluated by LPA Rivera. LPA observed central AC /heater and vents located on the ceiling. LPA Rivera observed the thermostats located in the classrooms and the temperatures to range 69 to 70. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. LPA Rivera tested the carbon monoxide detector located in classroom 10 and LPA Rivera heard the sound, and it is operable. The last emergency drill was conducted on 2/6/26.

LPA Rivera observed sleeping cots to be in good condition. First aid kits supplies are kept inside the classrooms and LPA observed the kits to be complete. During this visit, lead teacher stated currently has children with prescribed medication. LPAs observed child #1 Epinephrine expires 1/2027, child #2 Albuterol expires 3/30/27, child # 3 Albuterol expires 12/31/26, child #5 Albuterol expires 05/2027, child #6 Albuterol expires 04/2027 and child #7 Albuterol expires 02/2027. LPAs observed the medication stored in the classrooms inside a red backpack and hooked high up making it inaccessible for children to reach. LPA Rivera asked if there were any poisons, firearms, weapons or bodies of water. The Lead Teacher stated there's no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Lead Teacher Jasmine stated the ill isolation area takes place in the conference room and children utilize the classroom restroom. LPA informed children need to use an isolation restroom. LPA Rivera did not observe lead testing report.

LPA Rivera entered the outdoor play area. LPA Rivera observed the playground to be fenced all around and the gates closed and locked with a self-latch. LPA Rivera observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA Rivera observed play structure equipment ages 2-5 years and to be age appropriate and areas around or under high climbing equipment, are cushioned with granulated rubber mat that may absorb a fall. For adequate shade, LPA Rivera observed 2 hip roof shade structures. LPA observed trash bins with lids. For outdoor water drinking, staff bring out water pitchers and children cups.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/06/2026
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This program provides meals and snacks. Meals and snacks are prepared offsite at the head start kitchen. LPA Rivera informed lead teacher that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Rivera observed water pitchers, water dispenser and disposable cups. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects and rodents.


The following documents were posted in a prominent, publicly area front lobby: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and PUB 269 Child Passenger System Poster, and Daily Schedule.

LPA Rivera reviewed the children’s roster, children’s files, staff files, and sign in/out sheets and observed 47 signed in signatures. LPA Rivera observed children and staff files up to date and complete. Staff files are digital.

LPA Rivera observed lead teacher Jasmine Ruiz Emergency Medical Services Authority Pediatric First Aid/CPR certification dated 3/28/2025, has proof of immunization against Pertussis, MMR and Influenza declination. Lead Teacher has completed the mandated reporter training dated 4/25/26. Lead Teacher was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com


The following was also discussed with Lead Teacher:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/06/2026
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3. Current Children’s Roster: Each childcare 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.

4. LIC 125 Entrance Checklist provided, and LPA informed that forms, regulations and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.
5. Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

6. Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7. Qualifications: Educational background, training, and/or experience for each staff present must be available for review.

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination

9. Children’s Records: must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.



10. Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, Mandated Child Abuse Certification, MMR, TDAP, TB, influenza or influenza declination.

11. Isolation- When a child is ill, he/she shall be separated from other children, and remain separated.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/06/2026
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12. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

13. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624).

14. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

15. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and carbon monoxide detectors should be checked, and batteries replaced as needed.

Lead Teacher was reminded that all adults 18 and 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.

For child care 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 21-21.1CCP).



LPA referred Lead Teacher to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/06/2026
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For IMS information see PIN 22-02-CCP. 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-carecenters/.

Lead Teacher Jasmine was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care 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.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with Lead Teacher Jasmine Ruiz.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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