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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750066
Report Date: 12/11/2024
Date Signed: 12/11/2024 02:52:16 PM

Document Has Been Signed on 12/11/2024 02:52 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:SAN GORGONIO INFANT/TODDLER CENTERFACILITY NUMBER:
367750066
ADMINISTRATOR/
DIRECTOR:		LATASHIA KELLYFACILITY TYPE:
830
ADDRESS:2299 PACIFIC STREETTELEPHONE:
(909) 880-6706
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 22DATE:
12/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lorena Rodriguez-Peterson, and Mary Moorer, Program SpecialistTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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On 12/11/2024 Licensing Program Analyst Isabel Ortega met with facility Director Lorena Rodriguez-Peterson and conducted an Annual-Random Inspection. LPA toured and inspected the facility in accordance with the facility sketch. At time of entry LPA observe 5 Infants, 17 Toddlers in care and 8 staff providing care and supervision. Shortly after Mary Moorer, Program Specialist arrived to the facility

Facility has an infant program with the toddler option with parent consent for the toddler option component. One classroom is utilized for Infant and Toddler care, the room has areas enclosed for non-mobile infants, toddlers and crib area is enclosed.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed individual storage/cubbies for infant and toddler’s belongings with name labeled. The classroom consists of filtered water with individual bottles and cups. LPA observed 5-gallon filter water and a water dispenser in the classroom.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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: SAN GORGONIO INFANT/TODDLER CENTER
FACILITY NUMBER: 367750066
VISIT DATE: 12/11/2024
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The facility provides washed bottles daily which are utilized for water, milk formula and/or breast milk. The bottles are labeled with name of Infant and sterilized daily (LPA observed a Wabi sterilized machine). Facility tested the water fixtures for lead on 9/7/2023 and results were under the 5.5ppb allowed. Blankets and sheets are provided by facility and washed daily and as needed.

An isolation area was inspected, which takes place in a designated area in the classroom and/or school campus nurse’s office. Infants are provided with individual cribs for each infant in care, older mobile infants are provided with labeled cots.
LPA observed an appropriate changing table to be clean and sanitary and sink meeting Title 22, Regulations (arm distance from changing table). Facility has an Emergency Kit in the classroom and a thermometer.

Facility operates Monday through Friday from 7:00 a.m. to 5:30 p.m.
First Aid supplies, smoke detectors, carbon monoxide (tested at 11:45 a.m. and fire extinguishers (serviced 6/12/2024) were observed and in operable condition. Trash cans with tight lids were observed. Facility providers infants and toddlers with a schedule breakfast, lunch, and afternoon snack. Facility has snacks available as needed. Food was inspected, and are properly labeled, stored, and within expiration date. Cleaning supplies are out of reach of children.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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: SAN GORGONIO INFANT/TODDLER CENTER
FACILITY NUMBER: 367750066
VISIT DATE: 12/11/2024
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Emergency Drills are conducted monthly, last drill was conducted and documented on 12/03/2024 at 10:35 a.m. recorded as a sunny day. Food allergies are noted in the classroom and are posted in the food preparation area.

The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. During indoor and outdoor play children are provided with non-contaminated water, which was sampled on 9/07/2023, and results were under 5.5 ppb. There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area.



During the inspection LPA observed adequate teacher child ratio in each classroom. Care and supervision were evaluated and determine to meet the basic needs of children. A review of the sign in/out sheets were conducted to verify the current census of children. The parent board was reviewed and has all the required forms posted accessible to parents.
Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams, LIC9227 Infant sleep plan and infant 15-minute checks were observed by LPA, Immunization Records are all in the children's file. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.
The Site Supervisor is currently certified in Pediatric CPR/First Aid which does not expires on 12/04/2026.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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: SAN GORGONIO INFANT/TODDLER CENTER
FACILITY NUMBER: 367750066
VISIT DATE: 12/11/2024
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The following Incidental Medical Services (IMS) were discussed. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

All staff are required to take 3-hour Mandated Reporter training every 2 years. www.mandatedreporterca.com. Childcare Provider Mandated Reporter (General/AB1207) is dated 6/04/2024.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following websitewww.mandatedreporterca.com. Director is aware all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hot-line at (800) 540-4000.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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: SAN GORGONIO INFANT/TODDLER CENTER
FACILITY NUMBER: 367750066
VISIT DATE: 12/11/2024
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Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations. For additional information and forms visit our website at: www.cdss.ca.gov

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

Per Title 22 Regulations facility is in compliance, no deficiency will be issued today. An exit Interview was conducted with Site Supervisor Lorena Rodriguez-Peterson, and Mary Moorer, Program Specialist. Technical violations were provided as a form of prevention. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

A copy of this report must be made available to the public for 3 years. And the Notice of site visit shall be posted visible to parents for 30 days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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