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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820543
Report Date: 03/12/2026
Date Signed: 03/12/2026 01:09:54 PM

Document Has Been Signed on 03/12/2026 01:09 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: 17DATE:
03/12/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:09 AM
MET WITH:Nadine ArvizuTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On March 12, 2026, Licensing Program Analyst (LPA) Calloway, made an unannounced case management inspection to the above facility. The purpose of the case management was to follow up on a self-reported Unusual Incident Report (UIR) submitted to the Palmdale Regional Office on March 6, 2026. LPA met with Nadine Arvisu, facility representative who granted access and observed seventeen (17) preschool day care children and four staff in active care.

On March 6, 2026, the reported information involved a child (C1) on the playground sitting on the edge of the play structure, released their hands, and fell backwards. Staff gave C1 an ice pack and took C1 to the nurse’s office and the parents were notified. When the parent took C1 home, C1 stated they were pushed off the play structure by another child (C2). The parent returned to the school and requested to view video footage of the incident.

During this inspection, LPA conducted interviews with all relevant parties involved. LPA conducted a safety inspection of the playground and play structure. LPA viewed the video footage and observed C1 and C2 were facing one another on the upper portion of the play structure then, C2 placed their hands on the bars above C1. It was not clear in the video footage if C1 were sitting or standing. The video revealed C1 fell backwards off the play structure without assistance. Staff were in the area, but the incident occurred suddenly and could not be avoided.

Based on observation, interviews, and record review, the staff followed the proper protocol and administered aid to C1 and notified the parents in a timely manner.

There are no deficiencies cited during this inspection.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, was given to Nadine Arvisu, representative at the facility. 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: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2026
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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