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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750001
Report Date: 10/20/2022
Date Signed: 10/20/2022 04:27:33 PM

Document Has Been Signed on 10/20/2022 04:27 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:OAK TREE LEARNING CENTERFACILITY NUMBER:
367750001
ADMINISTRATOR:CARTER, JENNIFERFACILITY TYPE:
850
ADDRESS:680 W 40TH STTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 41DATE:
10/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Director Melissa Davis TIME COMPLETED:
04:30 PM
NARRATIVE
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On October 20, 2022 at 2:00pm Licensing Program Analyst (LPA) Zirbes, met with facility representative Katie and Director Melissa to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self-reported unusual incident report (UIR) submitted on to the Department on October 17, 2022. The unusual incident report was regarding a supervision incident involving child 1. Upon arrival, there were 41 children and 8 staff present at the facility.

During this inspection, interviews were conducted with staff and one child. In addition, LPA reviewed staff and children files. Furthermore, LPA also completed a safety inspection of the Center.

Based on interviews and record review, it was determined that C1 was left unsupervised in the classroom area for an undetermined amount of time. Director noticed C1 was unsupervised when C1 opened the office door where the Director and additional staff were sitting. The incident occurred while all other children and all teachers were in outdoor play area. A total of 35 children and four staff members were present when the incident occurred. After the incident the Director immediately toured the Center and did not locate an open door where C1 could have gained access to the classroom. Based on confidential interviews, C1 was observed in the outdoor play area with the other children. However, it is unknown how C1 obtained access inside the Center therefore leaving C1 unsupervised. The area C1 was left unattended is secured and C1 did not leave the premises. After the incident, management had a meeting with each staff member and provided retraining. Although the management took appropriate action, the care and supervision violation did occur.


A deficiency is being cited based on interviews, in accordance with California Code of Regulations, Title 22, see LIC 809D.
An exit interview was conducted, where the plan of correction was reviewed and developed with Melissa Davis. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative Melissa Davis.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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Document Has Been Signed on 10/20/2022 04:27 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 10/20/2022 at 02:18 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: OAK TREE LEARNING CENTER
FACILITY NUMBER: 367750001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2022
Section Cited
CCR
101229(a)(1)

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101229 (a)(1) Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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Per Director, the twos will utilize the two year old playground at all times, staff meeting will occur to go over the Title 22, regulations, Director had a meeting with the staff and discussed communication and provided staff support and retraining. Director will meet again with the staff in 14 days.
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Based on interviews, it was determined that C1 was left unsupervised in the classrooms for a undetermined amount of time. This poses a potential risk to the health, safety or personal rights of 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.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


LIC809 (FAS) - (06/04)
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