197409137-1-6-2026-12-CC-MRIA-DQ3TYK-20260106140851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409137
Report Date: 01/06/2026
Date Signed: 01/06/2026 02:09:32 PM

Document Has Been Signed on 01/06/2026 02:09 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:	NOTRE DAME INFANT CENTER		FACILITY NUMBER:	197409137
ADMINISTRATOR/ DIRECTOR:	ANGELICA RODRIGUEZ		FACILITY TYPE:	830
ADDRESS:	21704 GOLDEN TRIANGLE RD.#120		TELEPHONE:	(661) 255-0053
CITY:	SAUGUS	STATE: CA	ZIP CODE:	91350
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 16	DATE:	01/06/2026
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:49 AM
MET WITH:	Tracy Melvin, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:35 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 Tuesday, January 6, 2026, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with administrator Tracy Melvin who guided LPA Rivera on a tour of the facility. This is an infant program with toddler option component that serves children ages 0 to 36 months. This program operates Monday to Friday 7:00 a.m. – 6:00 p.m. Sign in and out takes place at the main entrance area. Teacher and child ratio were observed. Present staff are fingerprinted cleared and trained in pediatric first aid/CPR. Annual fee is current, and facility has an approved outdoor waiver for infant and toddler playground. LPA entered the infant 1 classroom. LPA Rivera observed 6 infants with staff #1 and staff #2 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored inside bottom sink cabinet with a children proof lock making it inaccessible for children to open. LPA Rivera observed two step trash bins with a lid, one for diapers and one for trash. LPA observed the diapering changing table to be arm’s length to the handwashing sink and a vinyl diapering mat. Per administrator Tracy, soiled clothing is not rinsed in the sink. It is placed in a plastic bag and the vinyl mat is disinfected with disinfecting solution. LPA observed children’s personal items in the cubbies with individual bins. LPA also observed infant bottles and food to be labeled with names inside the refrigerator in their own individual bins. LPA reminded to add dates. LPA entered the walking infant 2 classroom. LPA Rivera observed 4 infants with staff #3 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: NOTRE DAME INFANT CENTER	FACILITY NUMBER: 197409137
	VISIT DATE: 01/06/2026

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sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored inside bottom sink cabinet with a children proof lock making it inaccessible for children to open. LPA observed cots to be in good condition. LPA Rivera observed two step trash bins with a lid, one for diapers and one for trash. LPA observed the diapering changing table to be arm’s length to the handwashing sink and a vinyl diapering mat. Per administrator Tracy, soiled clothing is not rinsed in the sink. It is placed in a plastic bag and the vinyl mat is disinfected with disinfecting solution. LPAs observed children’s personal items in the cubbies with individual bins. LPA also observed infant bottles and food to be labeled with names inside the refrigerator in their own individual bins. LPA reminded to add dates.

LPA did not observed infants napping. LPA observed the cribs to be free from bumper pads, pillows, toys, blankets, and hanging above items.

LPA entered the toddler’s classroom. LPA Rivera observed 6 toddlers with staff #4 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored inside top cabinet located in the bathroom. LPA observed cots to be in good condition. LPA Rivera observed two step trash bins with a lid, one for diapers and one for trash. LPA Rivera observed the diapering changing table located in the bathroom. LPA informed administrator when in use, to ensure it is arm’s length to a hand washing sink. Administrator stated soiled clothing is not rinsed in the sink. It is placed in a plastic bag and the vinyl mat is disinfected with disinfecting solution. LPAs observed children’s personal items in the cubbies with individual bins.

LPA Rivera observed restroom located in the toddler’s classroom. LPA observed one toddler toilet and one handwashing sink. LPA observed a total of 3 handwashing sinks, 3 diapering tables and 1 toddler toilet.

Heating, lighting, and ventilation were evaluated by LPA Rivera. LPA observed central AC /heater and vents located on the ceiling. LPA observed the thermostat located in the hallway and the temperature to be at 68 degrees. The facility did not feel to be 68 degrees and felt more like 70 degrees. Smoke detectors. we’re not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. The carbon monoxide detector in infant 1 classroom and toddlers were tested and LPA Rivera heard the sound, and they are operable. The last emergency drill was conducted on 10/3/25.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NOTRE DAME INFANT CENTER	FACILITY NUMBER: 197409137
	VISIT DATE: 01/06/2026

NARRATIVE

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First aid kits supplies are kept inside the classrooms and LPA Rivera observed the kits to be fully equipped with band aids, gauzes, adhesive bandages, and antiseptic wipes. During this visit, administrator stated currently has no children with medication or severe food allergies. LPA Rivera asked if there were any poisons, firearms, weapons, or bodies of water. Administrator stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Administrator stated the ill isolation area takes place in the director’s office and children utilize the staff restroom. Lead testing was conducted on 2/17/2023 and no lead exceedance. . LPA observed two water heaters located outside. One water heater temperature is at 120 and the other one reads hot.

LPA Rivera entered the outdoor play area. LPA Rivera observed the playground to be fenced all around and the gate that leads to the parking lot, closed, and locked with a self-latch. LPA Rivera observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA Rivera observed play structure equipment to be age appropriate and did not observe climbing equipment. LPA observed the yard to have artificial grass turf. For adequate shade, LPA Rivera observed 2 triangular hip roof shade structures. LPA Rivera observed a trash bin with a lid. For outdoor water drinking, staff bring out water pitchers and children sippy cups. LPA Rivera observed a storage shed and observed the door closed and locked with a key.

This program provides snacks and lunch for those who do not have dietary restrictions or food allergies. For infants, parents provide the formula, milk and food. Meals and snacks are prepared onsite. LPA Rivera informed administrator that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Rivera observed water pitchers, bottles, and sippy cups in the classrooms and water filtered dispenser in the hallway. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects, and rodents.

The following documents were posted in a prominent, publicly area front lobby: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and PUB 269 Child Passenger System Poster, and Daily Schedule.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NOTRE DAME INFANT CENTER	FACILITY NUMBER: 197409137
	VISIT DATE: 01/06/2026

NARRATIVE

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LPA Rivera reviewed the children’s roster children’s files, needs and service plan and staff files. LPA Rivera reviewed 15-minute sleep logs and sign in/out sheets and observed 16 signed in signatures.

LPA Rivera observed director Divinity Warren, American Red Cross Pediatric First Aid/CPR certification dated 3/17/24, Preventative Health and Safety with nutrition and lead component dated May 4, 2024, and May 5, 2024 and has proof of immunization against Pertussis, MMR, and Influenza declination. Director has completed the child abuse mandated reporter training dated 9/8/24. Director was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA Rivera observed administrator Tracy Melving American Red Cross Pediatric First Aid/CPR certification dated 1/20/25, Preventative Health and Safety with nutrition and lead component dated 3/28/23 and has proof of immunization against Pertussis, MMR, and Influenza declination. Administrator has completed the child abuse mandated reporter training dated 1/15/2024.

The following was also discussed with administrator:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

4.LIC 125 Entrance Checklist provided, and LPA informed that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NOTRE DAME INFANT CENTER	FACILITY NUMBER: 197409137
	VISIT DATE: 01/06/2026

NARRATIVE

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5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present at all times.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review.

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination.

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address, and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10. Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, Mandated Child Abuse Certification, MMR, TDAP, TB, influenza, or influenza declination.

11.. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624).

Administrator Tracy 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.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NOTRE DAME INFANT CENTER	FACILITY NUMBER: 197409137
	VISIT DATE: 01/06/2026

NARRATIVE

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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.

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

LPA Rivera discussed the safe sleep regulations with administrator Tracy 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 administrator Tracy 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.

Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Administrator Tracy 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.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NOTRE DAME INFANT CENTER	FACILITY NUMBER: 197409137
	VISIT DATE: 01/06/2026

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	No deficiencies given. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with administrator Tracy Melvin.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC809 (FAS) - (06/04)

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