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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820543
Report Date: 10/31/2025
Date Signed: 10/31/2025 12:30:21 PM

Document Has Been Signed on 10/31/2025 12:30 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 SITTING BULL ELEMENTARY SCHOOLFACILITY NUMBER:
364820543
ADMINISTRATOR/
DIRECTOR:		MARLENE EMLAYFACILITY TYPE:
850
ADDRESS:19445 SITTING BULL ROADTELEPHONE:
(760) 240-5278
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 21DATE:
10/31/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nadine ArvizuTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On October 31, 2025, 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 facility representative who granted access. LPA and representative toured the facility inside and outside. LPA observed twenty-one (21) day care children in active play and three staff. The facility is open from 8:30 AM to 11:30 AM for morning session and 12:30 PM to 3:30 PM for the afternoon session Monday-Friday. All employees, and volunteers, 18 years and over have a Criminal Record Clearance (DOJ/FBI) and Child Abuse Central Index Clearance and are associated with the facility.
Physical Plant: There is one clean and safe classroom, the telephone service, heating, ventilation, and lighting are adequate. The daily schedule and activities were posted. There are cubbies for children's belongings in the classroom. The furniture, books, equipment, toys, and materials were appropriately aged and in good condition. There was a large activity rug inside the room for play. Representative stated the rug are deep cleaned five times a year and vacuumed daily. The drinking water is available inside the classrooms in the form of labeled water cups. There is no napping. First Aid Kits were in each classroom in a red duffle bag. There is an Emergency Survival Kit kept in the bathroom under the sink sealed. Trash cans have secure lids. 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.
Bathrooms: There were two children’s restrooms in the classroom each with one toilet and one handwashing sink and a changing table that functions properly and at the appropriate height.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2025
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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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.

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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 SITTING BULL ELEMENTARY SCHOOL
FACILITY NUMBER: 364820543
VISIT DATE: 10/31/2025
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LPA did not observe any accessible hazards. There was soap, toilet paper, and paper towels available. The staff restrooms are outside of the classroom in a separate staff lounge.
Kitchen: There is a kitchen that is not in use and used for storage. The facility provides morning and afternoon snacks from the school cafeteria. The menus are posted inside the classroom. There is a confidential allergy list posted on the wall. LPA observed an appropriate amount of food and snacks and 1% milk. The chemicals and cleaning supplies are kept locked inside the kitchen. The staff’s food items are kept in the staff lounge.
Outside: Outdoor play equipment was inspected for safety, cushioning material, good repair and is age appropriate. LPA observed a large play structure with three slides securely anchored in the ground with a canopy for shade and a rubber mat as a cushioned surface. There are bikes, tables/benches for shade and concrete and grass for active play. The playground was observed to be free of debris. Drinking water is available in the form of labeled water cups. Representative stated there are no bodies of water on the premises. LPA did not observe any. The fencing is concrete block wall, observed locked and is secure around the entire playground.
Other Review: Children and staff files were reviewed. Current Pediatric CPR/First Aid (expires: 7/2027). Transportation is not provided. Disaster Drills: Fire Drill was conducted: 9/18/25. Earthquake drill was conducted: 10/23/25 and the Shelter in place drill was conducted: 9/26/25. Representative stated the last facility fire inspection was conducted: 11/2024. The child/parent roster was incomplete it was missing the physician’s names and physician’s phone numbers. Representative stated the physician information is kept separate on the emergency card. The staff/ child ratios were observed to be compliant; the sign in/out sheets were paper and legible. Representative stated the children are inspected for illnesses as they arrive. There is a separate isolation area for ill children in the corner of the room until the parent can pick up the child. Representative stated that medication is not provided. Staff interview was conducted with the representative and LIC 125 checklist was discussed.
The following was discussed with the representative:
Facility representative was reminded to access the CCLD Licensing website at www.ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates. All representatives are responsible for knowing the regulations when providing care. All employees should know their role and responsibilities of being a Mandated Reporter.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
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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 SITTING BULL ELEMENTARY SCHOOL
FACILITY NUMBER: 364820543
VISIT DATE: 10/31/2025
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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.

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.

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.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
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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 SITTING BULL ELEMENTARY SCHOOL
FACILITY NUMBER: 364820543
VISIT DATE: 10/31/2025
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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 for LIC 624 via email to unusualincidentreport@dss.ca.gov or via fax (661) 202-3810 within seven days of reporting.

There is a deficiency cited during this inspection. See LIC 809D page attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit (LIC 9213), this report, and Appeal Rights were provided to Nadine Arvizu, Facility Representative. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/31/2025 12:30 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 10/31/2025 at 12:15 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: AVUSD SITTING BULL ELEMENTARY SCHOOL
FACILITY NUMBER: 364820543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited

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§1596.841 Current roster of children provided care in facility required...
The roster shall include the name...and telephone number of the child's physician. ...roster shall be available to the licensing agency upon request. This requirement was not met as evidenced by:

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Based on observation, interview, and record review the child/parent roster did not have the required physician's names and phone numbers as a completed roster during the inspection which poses a potential health, safety, or personal rights risk to the 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.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2025


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