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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750022
Report Date: 04/15/2026
Date Signed: 04/15/2026 10:42:43 AM

Document Has Been Signed on 04/15/2026 10:42 AM - 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:ANTELOPE ELEMENTARY SCHOOLFACILITY NUMBER:
197750022
ADMINISTRATOR/
DIRECTOR:		SUSAN GAINESFACILITY TYPE:
850
ADDRESS:37237 NORTH 100TH STREET EASTTELEPHONE:
(661) 944-2148
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: DATE:
04/15/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Cindy Bahena, facility representativeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 4/15/26, Licensing Program Analyst (LPA) Ana Rodriguez met with facility representative Cindy Bahena to conduct an unannounced Annual/Random inspection. LPA explained the purpose of the inspection and was granted entry to the facility. Using the facility sketch, LPA toured the center both indoors and outdoors. This center, located on the Antelope Elementary School campus and part of the Keppel Union School District, is physically separated from the public-school area. The center is in two bungalow classrooms: rooms 1 and 2 for the preschool program. LPA Rodriguez inspected both classrooms, which operate Monday through Friday with an AM session from 8:30 am to 11:30 am and a PM session from 12:30 pm to 3:30 pm. Incidental Medical Services (IMS) were discussed. During today’s inspection, there are 9 children with 1 teacher and 2 aides in classroom #1 and 12 children with 1 teacher and 2 aides in classroom #2.
Physical Plant: LPA toured and inspected the preschool classrooms. Furniture and equipment were checked for age appropriateness and good repair; all rooms were clean and safe. Telephone service was verified, and heating, lighting, and ventilation were adequate. Each child has a labeled cubby for their belongings, and age-appropriate toys and materials were available. A daily activity schedule was displayed in each classroom. Drinking water is accessible through disposable paper cups and water jugs. The facility is equipped with a smoke detector and a carbon monoxide detector. All containers for solid waste, including movable bins, have tight-fitting, leakproof, and rodent-proof covers.
Bathrooms: LPA inspected the children’s bathrooms. Classroom 1 contains 2 toilets and 3 sinks, which function correctly and are age appropriate. Classroom 2 also has 2 toilets and 3 sinks, all in good working order and suitable for children. Staff use a separate bathroom located across the yard. Soap, toilet paper, and paper towels were readily available in each bathroom.
Outdoor Area: Outdoor play equipment was inspected for health and safety. The playground, covered in sand to cushion falls, is fully fenced with a chain link fence. The side of the fence leading to the road has a privacy screen.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2026
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: ANTELOPE ELEMENTARY SCHOOL
FACILITY NUMBER: 197750022
VISIT DATE: 04/15/2026
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The play area serves as a shared play area for preschool, TK, and kindergarten students. Per facility representative there is a set schedule in which only one class at a time is in the play area. The sand is raked daily and was observed to be free of debris. Large and small play structures are securely anchored. There is a picnic table with a shaded by a canopy. Drinking water is available through water jug and paper cups. If the children need to use the restroom, they will utilize the restrooms in the classroom. The outdoor area was checked for hazards, and there are no accessible bodies of water. Children are screened for illnesses upon arrival. A review of the medication policy confirmed that prescription medication is administered only with parental permission. The school nurse administers medication, documenting the dosage, date, and time on a log. All medication will be labeled and stored in its original container and kept at the school nurse until expiration. At this point, it is sent home with the parent for disposal. The school Nurse office includes a designated space for isolating and caring for ill children, with a mat available and an isolated toilet. It sinks in the staff restroom for their use. The classroom keeps their own fire and earthquake drill log, and the preschool classrooms follow the school’s fire drill schedule. Last disaster drills was conducted and documented on 3/20/26. A current roster is available. An operational telephone is located within the childcare center. LPA observed a fully stocked first aid kit. The parent information board was reviewed and contains all required postings. Sign-in and sign-out sheets were examined. The teacher-to-child ratio was observed, and staff names were recorded. Care and supervision were assessed to ensure the children’s basic needs were being met.
Staff and Children’s Records: LPA reviewed records for 5 children and 3 staff. All files were complete. Three staff in room 2 have current pediatric CPR and first aid certification. Mandated reporter was also observed to be current.
Food Service: The school kitchen provides food, offering breakfast, lunch, and an afternoon snack. Allergy lists are posted in the classrooms. LPA observed that food and snacks were appropriate in quantity, and staff handled food preparation with gloves. Food preparation and storage areas are kept clean and free of litter. Cleaning products are stored separately from food. Menus are posted at least one week in advance and made available for parents to review.
The following general information was discussed during this inspection:

-Facility representative 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.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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: ANTELOPE ELEMENTARY SCHOOL
FACILITY NUMBER: 197750022
VISIT DATE: 04/15/2026
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 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.

-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 as specified in Health and Safety Code section 1597.16. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.). LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. Facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

-Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

- Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare 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.



No deficiencies are being cited at this time, the facility complies with Title 22

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Cindy Bahena.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC809 (FAS) - (06/04)
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