367750049-6-21-2024-12-CC-KZIS-D6FU6X-20240621151906

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367750049
Report Date: 06/21/2024
Date Signed: 06/21/2024 03:19:33 PM

Document Has Been Signed on 06/21/2024 03:19 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 STREET		FACILITY NUMBER:	367750049
ADMINISTRATOR/ DIRECTOR:	MELISSA DAVIS		FACILITY TYPE:	850
ADDRESS:	1900 D STREET		TELEPHONE:	(909) 882-6979
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS: 24	DATE:	06/21/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Facility Representative Juanita Gutierrez and Ghada Ponce		TIME VISIT/ INSPECTION COMPLETED:	03:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On June 21, 2024 at 08:45am, Licensing Program Analyst (LPA) Kendal Zirbes met with Facility Representative Juanita Gutierrez. The purpose of the inspection was to conduct a case management annual continuation inspection at the licensed facility. LPA disclosed the purpose of the inspection to the facility representative. Present during today’s inspection were 16 preschool children and 8 toddlers, with two teachers, one administrative staff (facility representative) and one support staff. At 8:55am LPA walked into classroom 3 and classroom 4. LPA observed eight toddlers in classroom 3 with Staff 1 (S1) and Facility Representative Juanita Gutierrez providing supervision. LPA walked into classroom 4 and observed staff 2 (S2) providing supervision to 16 children. Staff 3 (S3) arrived to classroom 4 with one additional child. Based on LPA observation, S3 was alone and providing supervision to 16 children in classroom 4, which does not meet the teacher to child ratio of one teacher visually observing and supervising no more than 12 children,. When LPA questioned the facility representative about the ratios, facility representative stated four additional preschool children arrived right after each other and facility representative was in the process of moving staff. LPA reviewed the attendance records. Based on LPA review five preschool children arrived between 8:42am and 8:56 am. Even though the children arrived within a small time frame the Center must maintain a ratio of one teacher supervising no more than 12 children. A type A citation was issued for regulation 101216.3(a), refer to LIC 809D. Child/Personnel Records LPA reviewed five child records and five personnel files during this inspection. Per LPA's review the child files were complete and contained all the required documentation. Per LPAs review one of five personnel records did not complete the child care provider specific component of the mandated reporter training, a technical advisory notice was issued. Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 7 of 12

Document Has Been Signed on 06/21/2024 03:19 PM - It Cannot Be Edited

Created By: Kendal Zirbes On 06/21/2024 at 01:21 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: 06/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101216.3(a)

Teacher-Child Ratio

(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when Staff 1 was supervising 16 children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/21/2024
	Plan of Correction
1 2 3 4	Per facility representative, the facility will be revisiting the hours that the staff come in to ensure proper compliance. The facility was brought into ratio during this inspection. A copy of the updated LIC 500 will be submitted to the Department two weeks.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 06/21/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

Page: 8 of 12

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: 06/21/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from page one

Facility Records
LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility. LPA observed the disaster drill log (last drill completed in May 2024) and sign in/out records.

Posting Requirements: Center has required postings posted (license, PUB 393, car seat law information).
LPA discussed the safe sleep regulations with 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.

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 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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.

Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

Page: 11 of 12

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: 06/21/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Report continued from page two
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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.

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.

As a result of this inspection, one type A citation and two advisory notices were issued.

LPA Zirbes informed facility representative, Ghada Ponce that this report dated June 21, 2024, 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 June 21, 2024, 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 Ghada Ponce and Juanita Gutierrez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

Page: 12 of 12