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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750001
Report Date: 12/08/2021
Date Signed: 12/09/2021 12:58:51 PM

Document Has Been Signed on 12/09/2021 12:58 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
CCLD Regional Office, 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: 24DATE:
12/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Director, MelissaTIME COMPLETED:
01:15 PM
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Licensing Program Analyst's (LPAs) Maddox and Ibitoye met with Director, Melissa Davis today for the purpose of conducting a a Case Management inspection regarding an Unusual Incident Report received. The incident occurred on a Wednesday, 12/1/2021.

Description of the incident: Director, Melissa received a call from child #1’s Mom stating she noticed something concerning as she bathed her daughter. Director informed Mom what the teacher provided about the incident. Teacher Sharlene Dayla reported around 4:30 PM, Elena was riding a bike on the bike path area. Suddenly, Elaina came crying to teacher, Sharlene who asked her what happened, according to the teacher, child #1 pointed to her bike and then pointed to her thigh. The Teacher asked her did she fall, child #1 answered “no” and got back on the bike and started to ride away and play with her friends.

Director stated she contacted Mom to see if she had taken child #1 to the Dr, mom stated she had not taken her that evening because there was an extensive wait at the Emergency room, Mom said she would take her the following day (Thursday, 12/2/2021). Director stated she spoke with Mom who informed her that she thinks the injury "may be a rash", and that she still hadn't taken child to see a Dr.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: OAK TREE LEARNING CENTER
FACILITY NUMBER: 367750001
VISIT DATE: 12/08/2021
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On Friday, child #1's Dad dropped her off in lieu of Mom, Director asked Dad was child #1 doing ok, according to Director, Dad responded "she's fine" and that was the end of the conversation. On the date of the incident there were 14 children and 2 Staff.

Based on information provided and interviews conducted the incident does not appear to have been the result of any violation of the Title 22 regulation. Exit interview conducted and a copy of report provided to Director, Melissa on this date.


LPA's also interviewed Director, Melissa regarding an incident involving child #2. Staff #1 witnessed Teacher, Ms. Robyn aggressively hit child#2 on the back forcing her to lay down during nap time. Staff #1 informed the Director immediately who interviewed other teachers and examined child #2 to make sure there were no noticeable marks on child. Staff #2 called out the following day which was Friday, she returned on that Monday, 12/6/2021 where the Director met with her and staff #2 was terminated. LPA Obtained termination letter and statement from the staff who witnessed the incident. This incident will be discussed with Management to determine if any further action is needed.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC809 (FAS) - (06/04)
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