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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750049
Report Date: 06/03/2025
Date Signed: 06/03/2025 04:27:23 PM

Document Has Been Signed on 06/03/2025 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:OAK TREE D STREETFACILITY NUMBER:
367750049
ADMINISTRATOR/
DIRECTOR:		MELISSA DAVISFACILITY TYPE:
850
ADDRESS:1900 D STREETTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 32DATE:
06/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Facility Representative Melissa DavisTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On Tuesday, June, 3, 2025 at approximately 9:20am, Licensing Program Analyst (LPA) Hanna Cha and Kendal Zirbes met with facility representative Josephine Hernandez. The purpose of the visit was to conduct an unannounced Annual/Random inspection of the facility. LPA disclosed the purpose of the inspection to the facility representative. LPA toured and inspected the facility. LPA observed three teachers and two teacher aides providing care and supervision to 23 preschool-aged children at time of inspection. Based on LPAs observation during the initial walk through, the facility was meeting the required staff to child ratios. The facility is operated on the grounds of First Presbyterian Church. The Preschool/Toddler component program consists of three classrooms, four restrooms, staff restroom, and an outdoor activity space. The facility also operates an Infant Center (#367750050). Both licensed components utilize the kitchen, staff restroom, staff offices, staff lounge, and storage spaces. The days and hours of operation are Mondays through Fridays; 6:30am-6:00pm.

Physical Plant/Indoor/Children’s Area: The facility was inspected for safety, comfort, cleanliness, telephone service, heating, lighting, ventilation, and good repair. LPAs observed two preschool classrooms, one toddler component classroom, four restrooms, and an outdoor activity space. At time of inspection, classroom #3 was used for the toddler component program and classroom #4, and #6 were primarily used for preschool children. There were labeled cubbies for children's belongings in each classroom. Drinking water is available inside the classrooms via pitchers and personal bottles. Sufficient napping cots are provided for children.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: OAK TREE D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 06/03/2025
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Carbon monoxide detector and smoke alarms in operable condition. All trash bins were observed to have tight fitting lids. Per LPA observation, cleaning compounds were stored in classroom cabinets, made inaccessible to children by a safety lock. Additional cleaning compounds stored in staff lounge and kitchen. Per facility representative, there are no poisons on the premises. LPA observed the furniture/equipment for safety and good repair. The office is used as an isolation area for children who become ill. LPA did not observe prohibited childcare items. LPA observed no fireplaces and wall heaters.
Bathroom: LPA observed bathroom for safe and sanitary operating condition with no hazardous materials. The toddler component/preschool program utilizes four children restrooms. Two of four bathrooms primarily used by children while abiding to ratio requirements. Per facility representative and LPA observation, other two restrooms currently vacant but maintained and ready for use. There is also one staff restroom. Toilet paper, paper towels, and soap were available to children.
Kitchen: LPA observed the kitchen for safety, sanitation, and good repair. Kitchen is located in separate building and shared with First Presbyterian Church. Food and supplies are stored separately from church facility. Knives and sharp objects stored on top of the counter in the kitchen located at a separate building. The facility participates in a food program. Meals are prepared in the kitchen. Menus were posted in the classroom. Per LPA observation, food items are dated and stored properly.

Outdoor/Children’s Play Area:


LPA inspected the outdoor play space for safety, cleanliness, good repair, age-appropriate toys/equipment, cushioned floors, and shady areas. The preschool program utilizes a separate play area from the infant program. The outdoor area for the preschool program has one large play structure for children with wood chips as cushioning material to absorb falls. The large play structure was securely anchored to the ground. LPA also observed a swing set with wood chips as cushioning material, concrete bike trails, and a covered seating area with tables for manipulatives and drinking water. The toddler component outdoor area consists of smaller play structures with sandy areas and concrete areas. Both areas were observed to be free of debris at time of inspection. Drinking water is provided via a pitcher and personal water bottles. Per facility representative, water is disposed daily.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: OAK TREE D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 06/03/2025
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Pools/Spa/Bodies of Water: Per LPA observation, there are no pools, spas, or bodies of water on the premises.

Other: Per facility representative, smoking is prohibited on the premises. Per facility representative, there are no firearms/weapons stored on premises. Per recorded documentation, Emergency disaster drills last completed on 4/2025. Per recorded documentation, lead testing completed on 4/2024.

File Review: LPA reviewed ten child files which contained all required information. LPA reviewed seven personnel files during this inspection. Based on LPA record review, one of seven personnel files were missing health screenings. One of seven personnel files were missing immunizations. Per record review, the facility checklist regarding staff files did not include all requirements. LPA advised facility representative to update checklist to include all required documentation. LPA advised facility representative to review LIC 311A to ensure all files include required information.

Postings: LPA observed required postings as follows: Facility License, Personal Rights (LIC613A), Parent’s Rights Poster, Passenger Car Seat Law (PUB 269), and Emergency Disaster Plan.


To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: OAK TREE D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 06/03/2025
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

One Technical Violation issued at time of inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Josephine Hernandez along with Appeal Rights.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC809 (FAS) - (06/04)
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