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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750049
Report Date: 10/20/2022
Date Signed: 10/20/2022 10:28:29 PM

Document Has Been Signed on 10/20/2022 10:28 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 D STREETFACILITY NUMBER:
367750049
ADMINISTRATOR:JENNIFER CARTERFACILITY TYPE:
850
ADDRESS:1900 D STREETTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
10/20/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jennifer CarterTIME COMPLETED:
01:59 PM
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Licensing Program Analyst (LPA) Maddox met with Jennifer Carter, Applicant for the purpose of conducting a Pre-Licensing inspection for a Preschool component (for children ages 2 until entry into first grade) with a Toddler Option (age 18 mos - 36 mos) in Room #s 3,4,& 6. Applicant is requesting a capacity of 48 PS children and 12 Toddlers. The hours of operation will be from 6:30 am to 6:00 pm Mon- Fri. Applicant is also applying for an Infant License at this location (367750050) . This center was formerly licensed as the First Presbyterian Church (360910854).

INDOOR ACTIVITY SPACE: A comfortable temperature for children shall always be maintained. Furniture and equipment are maintained in good condition, free of sharp, lose or pointed parts. There are a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities. Tables and chairs were present to meet the needs of the children. Drinking water is readily available Water Pitchers with disposable cups and water bottles labeled with each child's name. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children will be stored in locked cabinets inaccessible to children. There is a fully stocked first-aid kit kept in the office with mini kits in the classroom.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
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 D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 10/20/2022
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· The isolation area will be located in the office for any child who becomes ill during the day. LPA observed working carbon monoxide detectors throughout and smoke detectors and fire extinguishers throughout the facility.
Center will use the bright wheel system to sign children in and out, with the capability to print out a hard copy if needed. The licensee shall conduct a well-ness check to ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.
OUTDOOR

There are 2 separate outdoor play yards, one for the Preschool and a separate one for Infant/Toddlers. There is a shaded rest area available; As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls (wood chips); Staff will bring drinking water outside in pitchers with disposable cups; there are no bodies of water on the premises, the entire yard is fenced, there is a swing set on the yard that is anchored and secured, LPA observed 1 large climbing apparatus that's age appropriate for PS children and free of any broken or sharp parts.

RESTROOMS

All toilets, hand washing and bathing facilities were maintained in safe and sanitary operating condition. There is a bathroom located in Room #6 which is designated for 4 & 5 year olds, and there are additional bathrooms located in the courtyard area (Girls bathroom has 4 stalls and 2 sinks, the Boys bathroom has 2 toilets, 2 urinals, and 2 sinks). The staff bathroom is located inside the main sanctuary (church).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
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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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 D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 10/20/2022
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SUPERVISION:

No child(ren) shall be left without the supervision of a teacher at any time, Supervision shall include visual observation.

TRANSPORTATION: Center will not provide transportation at this time

CHILDREN’S RECORDS:


All children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. Application packet list the required forms that are required for each child's records.
NAPPING: Cots will be used for napping, Each cot shall be equipped with a sheet to cover the cot and, depending on the weather, a sheet and/or blanket to cover the child. Cots or mats should be wiped with a detergent/disinfectant weekly or when soiled or wet. There are cubbies available to store children's belongings. Bedding shall be individually stored so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding.

HEALTH RELATED SERVICES:

Medications shall be kept in a safe place inaccessible to children.

A refrigerator shall be used to store any medication that requires refrigeration.

Applicant has implemented a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
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)
Page: 3 of 6
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 D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 10/20/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

FOOD SERVICES.

This center will be part of the CACFP (California Adult and Children's Food Program). Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food preparation areas, or areas where kitchen equipment or utensils are stored. Soaps, detergents, cleaning compounds or similar substances were stored in areas separate from food supplies. Food preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin. Trash cans, including moveable bins, shall have a tight fitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. There is a refrigerator available to store any medication that requires refrigeration. All foods shall be selected, transported, stored, prepared and served so as to be free from contamination and spoilage and shall be fit for human consumption.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
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)
Page: 4 of 6
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 D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 10/20/2022
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POSTINGS:

The licensee shall post signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5

Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.

Applicant is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.


Fire Clearance has been approved for the requested capacity (60).
Measurements:
Room #3 - Toddlers: 20 X 28 = 560-8 (enc space) = 552/35 = 16
Room $4 - PS: 30 X 20 = 600/35 = 17
Room #6 -4 & 5 yr olds 29 X 20 = 580/35 = 17
Total indoor space for PS = 50

Bathrooms:
1 bathroom between Rooms 3 & 4 (1 toilet and 1 sink) = 15
1 bathroom in Room #6 (1 toilet and 1 sink) = 15
Girls bathroom off the courtyard has 4 toilets and 2 sinks = 30
Boys bathroom off the courtyard has 2 toilets, 2 urinals, and 2 sinks = 30
Total capacity with bathrooms: 90
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
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)
Page: 5 of 6
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 D STREET
FACILITY NUMBER: 367750049
VISIT DATE: 10/20/2022
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OUTDOOR MEASUREMENT: 102 X 55 = 5610/75= 75

THE INDOOR SPACE HAS LOWEST MEASUREMENT WHICH TOTALS AN OVERALL CAPACITY OF 50 CHILDREN.

After conducting the file review, LPA noted the following need addressing prior to licensure:

-LIC 500 SHOULD LIST ADDITIONAL STAFF TBH TO MEET THE TEACHER CHILD RATIO FOR THE REQUESTED CAPACITY (may indicate TBH)
-. LIC 200 STATES 48 PS BUT THE PROGRAM GUIDE STATES 56 PS? DOES NOT MENTION REQ TO SIGN CHILDREN IN & OUT DAILY
-LIC 610 MISSING TELEPHONE NUMBER FOR SB POLICE & NEAREST HOSPITAL; NEED TO
CLARIFY TEMPORARY RELOCATION SITES; MENU MISSING PORTION SIZES
MEDICAL EMERGENCY SHOULD STATE CALL 911 THEN NOTIFY
PARENTS; DIRECTOR AND APPLICANT NEED TO TAKE OPERATIONS AND RECORDS KEEPING ORIENTATION; MISSING PROOF OF CURRENT IMMUNIZATION'S FOR MELISSA AND JENNIFER; MISSING 508 FOR MELISSA; MISSING HEALTH SCREENING FOR MELISSA; MISSING PROOF OF LEAD POISONING TRAINING
MISSING 501 FOR MELISSA; MISSING LIST OF FURNITURE AND EQUIPMENT; MISSING TRANSCRIPTS FOR MELISSA; MISSING CPR AND FIRST AID FOR JENNIFER OR MELISSA; MISSING PROOF OF MANDATED REPORTER TRAINING FOR JENNIFER AND MELISSA
THE ENTIRE CENTER NEEDS A GENERAL CLEANING AFTER SITTING IDLE FOR 2 YEARS.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
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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