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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750001
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:58:13 PM

Document Has Been Signed on 07/14/2022 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: 30DATE:
07/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Director, Melissa DavisTIME COMPLETED:
01:00 PM
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Licensing Program Analyst's (LPA) Maddox met with Director, Melissa Davis today for the purpose of conducting a Case Management inspection regarding an Unusual Incident that occurred on July 11, 2022.

Description of the incident: From interview with Director, On Monday, July 11, 2022, Parent called late that evening stating that child #1 told her that child #2 pushed his head in the toilet. Director asked Mom did child #1 tell any teachers about the incident, Mom stated child #1 told her he told teacher, Ms. Odalys. Director spoke with teacher Ms Odalys who stated child #1 wasn't in her care that day and she had no contact or conversation with child #1. Child #1 was asked was there anyone else that witnessed the incident, child #1 said child #3 witnessed the incident, however, according to Director, child #3 wasn't present on the date of the alleged incident. Parent of child #1 stated child #1 complained of his private area hurting, Director asked Mom was child seen by a Dr, Mom stated child only complained about his private area once and never mentioned it again, therefore, she never took child to seek any medical attention.

LPA asked the Director about their bathroom procedures, Director states that the girls go in at one time and the boys go in separately. Director stated child #1 constantly goes into stalls that are occupied by other children and staff re-direct him daily about going into occupied stalls. Further investigation will be required.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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