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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817587
Report Date: 07/16/2026
Date Signed: 07/16/2026 12:51:25 PM

Document Has Been Signed on 07/16/2026 12:51 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:AVUSD YUCCA LOMA ELEMENTARYFACILITY NUMBER:
364817587
ADMINISTRATOR/
DIRECTOR:		RHOADES,SUEFACILITY TYPE:
850
ADDRESS:21351 YUCCA LOMA RD.TELEPHONE:
(760) 247-2052
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
07/16/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:Theda SmithTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On July 17, 2026, at 10:24 AM., Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility for the purpose of conducting an Annual and Case Management inspection to reopen the classroom after being inactive. LPA met with Theda Smith and Reyna Martinez, as facility representatives who granted access. At 10:35 AM., LPA and representative toured the facility inside and outside. LPA observed no children in care. The facility will be open from 8:00 AM to 11:00 AM for the first session and 11:45 AM-2:45 PM for the afternoon session 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.
Physical Plant: The parent wall was in a prominent location on the left wall near the front entrance with the required postings. The sign in/out sheets will be paper. There is one large classroom, as Classroom #2 for the preschool children. The telephone service, heating, ventilation, and lighting are adequate. The daily schedule, and activities will be posted inside the classroom. There are cubbies for children's belongings that will be labeled with their names. The furniture, books, equipment, toys, and materials were appropriately aged, in good condition, and at the appropriate height. There was a large activity rug inside the classroom for play with a non-slip material. The drinking water is available inside the classrooms in the form of a water pitcher and personal water cups or disposable cups, and the representative stated the cups will be taken home daily. There will be no napping. First Aid Kits were in the classroom n a red backpack. There is a diaper changing table with a sink nearby that are operating properly and at the appropriate height with diapers and wipes. The representative stated emergency supplies are kept inside the kitchen of the elementary school and at the district office.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2026
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: AVUSD YUCCA LOMA ELEMENTARY
FACILITY NUMBER: 364817587
VISIT DATE: 07/16/2026
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The trash cans were observed with secure lids, and the temperature inside the room was comfortable. Representative stated the fire extinguishers, ceiling sprinklers, smoke detectors and carbon monoxide detectors throughout the day care center are all operable and will be checked on an upcoming fire inspection in August 2026. There are two drinking fountains outside next to the restrooms that the children will have access to. Inside the child restrooms are labeled one for boys and one for girls they each have one toilet stall and one hand washing sink. LPA did not observe any accessible hazards and there was soap, toilet paper, and paper towels available. There is an additional restroom for children if needed next to the staff restroom. The staff restrooms are in the auditorium outside of the classroom. The facility provides one snack that will come from the school cafeteria, and the menus will be posted inside the class. The staff’s food items were in a separate staff lounge. The cleaning supplies are kept underneath the sink in the classroom locked with a safety latch. There was a current water lead test conducted on May 26, 2026, testing the two fountains and the water sink inside the classroom. There was not a facility sketch attached to the report, but none of the water features showed elevated lead results.

Outside: Outdoor play equipment was inspected for safety, cushioning material, good repair and is age appropriate and at the right height. The children can reach the outdoor activity area safely from the preschool classroom by walking past two TK classrooms. LPA and representatives observed a large play structure with two large slides and a large canopy for shade, two climbing areas, a bridge, and steps with the height appropriate for the age group of children. There is a rubber mat as a cushioned surface. The playground is enclosed by a chain-linked fence to protect children and to keep them in the outdoor activity area. Representatives stated the playground will be shared with the three transitional kindergarten (TK) classrooms Room #3, Room # PK, and another TK classroom on the other side, but are in the same area of the preschool and have separate play schedules. LPA observed a sign attached onto two areas of the play structure that reads “for kids ages 2-5 years old. The drinking water is available in the form of a portable water pitcher and disposable or personal water cups. Representative stated there are no bodies of water on the premises; LPA did not observe any.

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

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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: AVUSD YUCCA LOMA ELEMENTARY
FACILITY NUMBER: 364817587
VISIT DATE: 07/16/2026
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There were discovery toys, a climbing tunnel, basketball court, and two storage sheds that were observed locked. There was grass for active play. The fencing is wrought iron, and chain linked six feet high and was observed locked and secure around the entire playground.
Other Review: Staff files were reviewed. Current Pediatric CPR/First Aid (expires: 1/2028). Representative stated transportation is not provided. Disaster Drills, child parent roster, and fire inspection will be conducted and provided once the school year begins in August 2026. The representative stated the children will be inspected for illnesses as they arrive. There is a separate isolation area for ill children inside nurses’ health office of the school until the parent can pick up the child. Representative stated that the medications are stored inside the health office of the school. Representatives 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. 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 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.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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: AVUSD YUCCA LOMA ELEMENTARY
FACILITY NUMBER: 364817587
VISIT DATE: 07/16/2026
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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 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.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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: AVUSD YUCCA LOMA ELEMENTARY
FACILITY NUMBER: 364817587
VISIT DATE: 07/16/2026
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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. 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 are no deficiencies cited during this inspection.

An exit interview was conducted, a copy of this report was read, a Notice of Site Visit (LIC 9213), this report, were given to Theda Smith, 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: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC809 (FAS) - (06/04)
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