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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750050
Report Date: 11/03/2023
Date Signed: 11/03/2023 04:15:50 PM

Document Has Been Signed on 11/03/2023 04:15 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:
367750050
ADMINISTRATOR:MELISSA DAVISFACILITY TYPE:
830
ADDRESS:1900 D STREETTELEPHONE:
(909) 882-6979
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
11/03/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Facility Representative Juanita GutierrezTIME COMPLETED:
01:30 PM
NARRATIVE
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On November 3, 2023, at 9:15 a.m. Licensing Program Analyst (LPA) Kendal Zirbes met with Facility Representative Juanita Gutierrez. The purpose of the inspection was to conduct a required one year inspection at the licensed facility. LPA disclosed the purpose of the inspection to the facility representative. Present during today’s inspection were 9 infant age children, one teacher (staff 2 (S2)), and one aide (staff 1 (S1), and an additional administrative staff member.
LPA observed staff 1 (S1) and staff 2 (S2) supervising nine infants in infant classrooms 1 and 2. S1 was supervising six children over 12 months in room 2 and S2 was supervising three infants under 12 months of age in room 1. This Center is approved for a toddler option in Room 3, which is associated with the preschool license. Classroom 1 and classroom 2 are designated as infant classrooms therefore the teacher child ratio is one teacher for every four infants. The Center was out of ratio therefore a Type A citation was issued as this is an immediate risk. During LPAs inspection, additional staff members arrived on site and infant were picked up by their authorized representative therefore the Center was brought back into ratio.

The Center Infant license consists of two classroom (1 and 2) and a outdoor activity area.
The Center shares a staff office, break room, kitchen with one other licensed component, Preschool program with a toddler option (7). The center operates 6:30am-6:00pm, Monday through Friday.

During LPAs tour of the Center, LPA observed S1 and S3 with six infants in an enclosed outdoor area "Magnolia Yard" which was not approved by the Department as a outdoor activity area. LPA advised the Center of the ratios when engaged in activities away from the Center and advised the Center to obtain parent permission for the children to utilize this space. A technical notice was issued.

Report continued on page two
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 04:15 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/03/2023 at 01:06 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: 367750050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101416.5(b)
Staff-Infant Ratio
(b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when one teacher and one aide were supervising 9 infants, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
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Per facility representative, staff members were immediately transitioned to different classrooms and additional staff member were brought to the site to meet the ratios. A staff training will take place to discuss the teacher/child ratios. A copy of the training will be submitted to the Department by 11.10.23
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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


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Document Has Been Signed on 11/03/2023 04:15 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/03/2023 at 01:06 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: 367750050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101438.3(c)(1)
Indoor Activity Space For Infants
(1) The sleeping area for infants shall be physically separate from the indoor activity space. This separation shall be accomplished as specified in (b) above.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above, in classroom 1 children were playing on the floor while other children were sleeping in cribs. Therefore the sleeping area was not physically separate from the activity space. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/10/2023
Plan of Correction
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Per facility representative a written plan of correction will be submitted to the Department by 11/10/23 to address the above citation.
Type B
Section Cited
CCR
101439(h)(4)
Infant Care Center Fixtures, Furniture, Equipment and Supplies
(h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the diaper changing table in classroom 2 was not within an arms reach of a sink which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/10/2023
Plan of Correction
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Per facility representative a written plan of correction will be submitted to the Department by 11/10/23 to address the above citation.
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


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Document Has Been Signed on 11/03/2023 04:15 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/03/2023 at 01:06 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: 367750050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, in classroom 1 scissors were observed on the table, in classroom 1, classroom 2, and the kitchen, items labeled "Keep out of reach of children" were located on low shelves behind closed cabinets, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/10/2023
Plan of Correction
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Per facility representative, the items will be relocated to a high shelf in the closet of the kitchen, the scissors were immediately picked up and child safety locks were placed back on the cabinets. A training will take place with the staff members. A copy of the training will be submitted to the Department by 11/10/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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


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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: 367750050
VISIT DATE: 11/03/2023
NARRATIVE
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Report continued from page one

Indoor/Children's Area: Infant Center is equipped with appropriate furniture and equipment. Furniture and toys were maintained in good repair, safe condition and was age appropriate. LPA did not observe sharp points or edges, or small parts that could be swallowed. During LPA's tour LPA observed the sleeping area located in classroom 1 was not physically separate from the infant indoor activity space located in classroom 1. LPA observed a child sleeping in a crib while other children were engaged in play on the floor of classroom 1. LPA did not observe moveable walls or partitions separating the sleeping space from the activity space. Facility representative confirmed the Center does not have moveable walls or partitions. A Type B citation was issued, for the observation. LPA observed trash cans for solid waste have tight fitting lids. All materials and surfaces are toxic free. No fireplaces were present. The Center had working telephone service on the premises. There is an isolation room for children who become ill while in care. The facility maintains a comfortable temperature at all times. Water is available inside the classrooms (sippy cups, bottles). Each infant/toddler has a container labeled with their name for the storage of personal items. No smoking is allowed on the premises.
During LPAs walk through of classroom 1 and classroom 2, LPA observed adult size scissors on the table in classroom 2. In an unlocked, closed cabinet in classroom 1 and classroom 2, diaper cream labeled "keep out of reach of children" was observed on shelf's within the unlocked cabinet that was less than 36 inches off the ground. LPA observed Bleach, Comet, Seventh Generation disinfectant spray in an unlocked closed cabinet under the sink in the kitchen located between classroom 1 and classroom 2. The door between the kitchen and classroom 1 was open and S1 was in the kitchen. LPA observed, child 1 crawl to the threshold of the kitchen which was with in two feet of the sink cabinet with the cleaning products. Due to the age and development of the children in care, the previous observation were a potential risk to the children in care, therefore a type B citation was issued.
When LPA was inspecting the kitchen, LPA observed one unlabeled container of oral pain relief nighttime medication in child 2 and child 3 labeled bucket. LPA advised the Center to label the medication container with the childs name and date.
Napping: LPA observed mats and cribs. LPA observed the crib mattresses were made of a cleanable vinyl material and were in good repair.
Other: Electrical outlets are inaccessible, there are no recalled and or prohibited toys or sleep/play equipment observed on the premises. Window cords were inaccessible to children.

Report continued on page three

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
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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: 367750050
VISIT DATE: 11/03/2023
NARRATIVE
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Report continued from page two

Restrooms: There is one children's restroom located between classroom 1 and classroom 2. LPA observed one toilet, one sink and one potty chair. During the tour, LPA observed diapering changing areas in classroom 1 and classroom 2. The diaper changing table in classroom 2 was not within an arms reach of a sink. The sink was located behind a closed door in the children's bathroom, therefore the sink was not within an arms reach. Type B citation was issued.

Outdoor: Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. The outdoor play area, has shaded and sunny areas. LPA observed a small climbing structure. The climbing structure was placed on rubber surfacing material and was securely anchored to the ground. Zero bodies of water were observed. The outdoor play space is completely fenced and separate from the playground utilized by the preschool component. At the time of this inspection. the outdoor space was is maintained in a safe condition and is free of hazards.

Based on LPA observation, interviews and record review, two advisories, one type A and three type B citations were issued today.
LPA Zirbes informed facility representative that this report dated 11/3/2023, 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.

LPA was unable to complete the entire annual inspection today. LPA will return to the facility another day to complete the inspection.



A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. 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
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