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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 04:28:10 PM

Document Has Been Signed on 10/20/2022 04:28 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:
12:01 PM
MET WITH:Director, Melissa Davis TIME COMPLETED:
02:00 PM
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On October 20, 2022 at 12:01pm 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 September 29, 2022. The unusual incident report was regarding a potential supervision violation involving child 1 (C1) and child 2 (C2). 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 and one child. In addition, LPA reviewed staff and children files. Furthermore, LPA also completed a safety inspection of the Center.

The information received from the UIR reported that on September 28, 2022, C1 was hit by C2 with a magnetic tile on the right side of the head. As a result of being hit, C1 started to bleed and the center provided first aid. In addition, authorized representatives were contacted. No additional medical attention was obtained. Based on the information received C1 may have been hit as a result of C1 knocking down C2s magnetic tile tower.


Based on LPAs record review and interviews at the time of the incident, there was one teacher providing supervision to eight children between the ages of two and three. Therefore the Center was within ratios. Confidential interviews reported there were zero previous altercations between C1 and C2. Furthermore, S1 was within auditory and visual range of the children when the incident occurred. LPA toured the classroom and observed the magnetic tiles C1 and C2 were playing with. Per the manufactures instructions the magnetic tiles should be utilized for children ages three plus.

Report continued on page two

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 367750001
VISIT DATE: 10/20/2022
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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. However, LPA advised the Center to ensure the materials in the classroom are age appropriate. LPA provided a technical advisory notice to the Center for regulation 101239 (m) Fixtures, Furniture, Equipment and Supplies. As the magnetic tiles were being utilized in the two year old classroom.

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
LIC809 (FAS) - (06/04)
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