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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 04:14:15 PM

Document Has Been Signed on 10/20/2022 04:14 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: DATE:
10/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Facility representative Melissa Davis. TIME COMPLETED:
12:00 PM
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On October 20, 2022 at 10:00am Licensing Program Analyst (LPA) Zirbes met with facility representative Katie and Director Melissa Davis 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 to the Department on August 25, 2022. The unusual incident report was regarding a potential personal rights incident involving child 1 (C1) and staff 1 (S1) . Upon arrival, there were 41 preschool age children, four teachers, one aide and two addition staff at the facility.

During this inspection, interviews were conducted with staff. Child interviews were not completed at this time due to the age and development of the children in the specific classroom. In addition, LPA reviewed staff and child files. Furthermore, LPA also completed a safety inspection of the Center.

Based confidential interviews and record review at this time, the incident does not appear to have been the result of a violation of the Title 22 regulation.

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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