367750050-7-30-2025-12-CC-LKIG-DK9MM3-20250805094312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 367750050
Report Date: 07/30/2025
Date Signed: 07/30/2025 01:47:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2025 and conducted by Evaluator Kendal Zirbes

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20250527170029

FACILITY NAME:	OAK TREE D STREET		FACILITY NUMBER:	367750050
ADMINISTRATOR:	MELISSA DAVIS		FACILITY TYPE:	830
ADDRESS:	1900 D STREET		TELEPHONE:	(909) 882-6979
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY:	12	CENSUS: 8	DATE:	07/30/2025
		UNANNOUNCED	TIME BEGAN:	12:44 PM
MET WITH:	Facility Representative Josephine Hernandez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff did not properly clean and sanitize day care child's drinking cup.

INVESTIGATION FINDINGS:

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On July 30, 2025, at 12:44pm, Licensing Program Analyst (LPA) Kendal Zirbes met with facility representative Josephine Hernandez. The purpose of the inspection was to deliver the finding for the above stated allegation.  During the investigation, LPA conducted interviews with parents and staff and reviewed photographic evidence. Interviews with children were not conducted due to the age and development of the children involved. In addition, LPA completed a review of the facility records and conducted unannounced inspections on June 3, 2025, June 10, 2025, and July 30, 2025.

On May 27, 2025, the Department received an allegation alleging Child 1 (C1) became ill due to the Center not cleaning and sanitizing C1 sippy cup on unknown dates between January 2025 until May 2025. Staff interviews reported the Center cleans and sanitizes the sippy cups each day and did not report concerns. Parent interviews did not report concerns and did not report their children have become ill due to attending the Center. During LPA’s unannounced inspections, LPA observed the children’s sippy cups to be clean and free of mold. Report continued on page two

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 12-CC-20250527170029

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 367750050
	VISIT DATE: 07/30/2025

NARRATIVE

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Report continued from page one

Based on interviews, record review and observation, there is not enough evidence regarding the allegation, facility staff did not properly clean and sanitize day care child's drinking cup. Therefore, the allegation is deemed unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Notice of Site Visit was given and must remain posted for 30 days. An exit interview was conducted, where this report and appeal rights were reviewed with facility representative Josephine Hernandez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025

LIC9099 (FAS) - (06/04)

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