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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408509
Report Date: 12/17/2025
Date Signed: 12/17/2025 01:30:38 PM

Document Has Been Signed on 12/17/2025 01:30 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SULPHUR SPRINGS UNION SCH.DIST.CANYON SPRINGS PRESFACILITY NUMBER:
197408509
ADMINISTRATOR/
DIRECTOR:		EDNA RODRIGUEZFACILITY TYPE:
850
ADDRESS:19059 VICCI STREETTELEPHONE:
(661) 252-8045
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 7DATE:
12/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:Edna RodriguezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On December 17, 2025, Licensing Program Analyst (LPA) Calloway, made an unannounced case management inspection to the above facility. The purpose of the case management was to follow up on a self-reported Unusual Incident Report (UIR) submitted to the Palmdale Regional Office on November 18, 2025. LPA toured the facility with the representative and observed seven-day care children and two staff in active care. All adults 18 years and over have Criminal Record Clearance (DOJ) and Child Abuse Central Index Clearance and are associated with the facility.

On 11/07/25, the reported information involved Staff observed Child 1 (C1) become ill while at the day care facility. According to the unusual incident report, C1 began to cry during the good bye song, their face was at first pale, then turned blue, C1 became unresponsive, and paramedics were notified. LPA conducted interviews with all relevant parties involved and reviewed records.

Based on interviews and record review, it was determined that C1 became ill towards the end of the day during pick up time and the incident was reported to the parent who was at the facility waiting outside. The staff followed protocol by immediately calling paramedics and providing aid to the child. The staff did not report the incident to Community Care Licensing (CCL) within the time frame specified in the regulations.



There are two Type B deficiencies cited during this inspection. See the LIC 809D page attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeal Rights were provided to Edna Rodriguez, Representative at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 12/17/2025 01:30 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 12/17/2025 at 12:51 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: SULPHUR SPRINGS UNION SCH.DIST.CANYON SPRINGS PRES
FACILITY NUMBER: 197408509

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2026
Section Cited
CCR
101212(d)(1)(B)

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10212(d)(1)(B) Upon the occurrence, ... child care center of any of the events specified...(d) below, a report shall be made to the Department by telephone or fax within the Department's next working day...(1) events reported..(B) Any injury to any child that requires medical treatment. This requirement was not met as evidenced by:
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I will have a meeting with the teachers to review the reporting requirements and timelines and will provide the agenda to Licensing and a sign in sheet of the staff in attendance.
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Based on interviews and record reviews the staff did not report the Unusual Incident to the Community Care Licensing office by the next working day according to the regulations which is a potential health, safety, or personal rights risks to the persons in care.
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Type B
01/19/2026
Section Cited
CCR101221(b)(8)

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101221(b)(8)Child's Records (b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ... and the following health information: This requirement was not met as evidence by:
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I will have the parent provide the most recent physicians report to Licensing
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Based on interview and record review Child 1(C1) did not have a physician's medical assessment in their file that was required no later than 30 days of the child's first day of enrollment which was in August 2025 which is a potential health, safety, or personal rights risks to the persons in care.
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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.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2025


LIC809 (FAS) - (06/04)
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