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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750049
Report Date: 11/03/2023
Date Signed: 11/03/2023 04:21:15 PM

Document Has Been Signed on 11/03/2023 04:21 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 D STREETFACILITY NUMBER:
367750049
ADMINISTRATOR:MELISSA DAVISFACILITY TYPE:
850
ADDRESS:1900 D STREETTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 17DATE:
11/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Facility Representative Juanita GutierrezTIME COMPLETED:
04:45 PM
NARRATIVE
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On November 3, 2023, at 02:31p.m. Licensing Program Analyst (LPA) Kendal Zirbes met with Facility Representative Juanita Gutierrez. The purpose of the inspection was to follow up on the health and safety check completed at 9:45am on November 3, 2023. Present during today’s inspection were 14 preschool age children, and two teachers.
At approximately 9:45 a.m., LPA conducted a safety inspection of the preschool center. LPA observed one fully qualified teacher (staff 1) and one aide (staff 2) supervising 17 preschool age children in the preschool and infant outdoor play space. Based on LPA conversation with the Administrator, S2 has not completed six postsecondary semester or equivalent quarter units in early childhood education or child development.

Based on LPAs observation and interview with Administrator, the licensee did not meet the ratio of one teacher and one aide for every 15 children in attendance. A Type A deficiency is being cited based on LPAs observation and interviews, in accordance with the California Code of Regulations, Title 22, see LIC809D.

LPA Zirbes informed Facility Representative Juanita Gutierrez that this report dated 11/3/23 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Zirbes informed the facility representative to provide a copy of this licensing report dated 11/3/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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 Juanita Gutierrez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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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Document Has Been Signed on 11/03/2023 04:21 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/03/2023 at 03:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: OAK TREE D STREET
FACILITY NUMBER: 367750049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2023
Section Cited
CCR
101216.3(b)

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101216.3 (b) Teacher-Child Ratio: The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. This requirement was not met as evidenced by:
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Per facility representative, the staff members were transitioned to other classrooms and Center was brought into compliance with ratio. A staff training will be conducted. A copy of the training will be submitted to the Department.
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Based on observation and interview, the Licensee did not ensure a teacher child ratio of one teacher and one aide for every 15 children in attendance when on 11/3/23, one teacher and one aide were supervising 17 children, which poses an immediate health and safety risk to children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023


LIC809 (FAS) - (06/04)
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