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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750068
Report Date: 04/03/2026
Date Signed: 04/03/2026 12:15:45 PM

Document Has Been Signed on 04/03/2026 12:15 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PEARBLOSSOM ELEMENTARY SCHOOLFACILITY NUMBER:
197750068
ADMINISTRATOR/
DIRECTOR:		SUSAN GAINESFACILITY TYPE:
850
ADDRESS:12828 EAST AVENUE WTELEPHONE:
(661) 944-6019
CITY:PEARBLOSSOMSTATE: CAZIP CODE:
93553
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 14DATE:
04/03/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Christina KnottTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 4/3/2026, Licensing Program Analyst (LPA) Ana Rodriguez met with Lead Teacher Karina Gonzales, to conduct an unannounced Annual inspection. LPA disclosed the purpose of the inspection and was granted entry to the facility. Upon arrival, LPA observed 1 classroom with 14 preschool children with 2 teachers and 2 assistants on the premises. The hours of operation are 8:25AM-11:30AM morning session and 12:25PM-3:30PM afternoon session, Monday - Friday. Incidental Medical Services (IMS) were discussed. According to the Facility Profile, the facility annual fees are current.
Indoor/Children’s Area: LPA toured and inspected the preschool classroom. Furniture and equipment were checked for age appropriateness and good repair. The room is clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings labeled with their names. LPA observed age-appropriate toys and materials. Trash cans for solid waste have tight-fitting lids, and drinking water is readily available indoors and outdoors (filtered water is available inside the center to fill each child's water bottle). All materials and surfaces are toxic-free and inaccessible. There is a working Carbon monoxide detector and smoke detector. Fire Extinguisher was last serviced 7/18/25(3A40BC). The First Aid kit was observed with readily available supplies (a thermometer). Electrical outlets are inaccessible. There are no window cords accessible to children. Sign-in and sign-out sheets were reviewed. The parent board was reviewed and has posted all of the required forms. Fire/earthquake drills last conducted on 1/27/26.
Restrooms: LPA inspected and observed Boys’ and Girls bathrooms. They have 4 toilets, 3 urinals, and 4 sinks, all in working order. LPA observed that soap, toilet paper, and paper towels were readily available. Water temperature is appropriate. There is an isolation area for children who become ill while in care located near the front office; the facility maintains a comfortable temperature at all times, and first aid supplies (thermometer, bandages, scissors), sign-in and out available and completed daily.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2026
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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 04/03/2026
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 Smoking is prohibited on the premises, daily inspection is required for illness, and no prohibited childcare items are observed. Firearms/weapons are not allowed on the premises. Napping: The program is 3 1/2 hours long, and according to the director, the children do not nap.
Outdoor: The facility has one playground area for the preschool children. A wall completely fences the outside play area. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. There is rubber matting and concrete areas for active play. The area was observed to be free of debris from hazards, holes, debris, and cushioning material underneath. Per facility representative monkey bars are off limits to preschool children. No bodies of water were observed. There are areas for shade and rest. Daycare children have their own personal water bottles as well as disposable cups. LPA observed a storage shed that is off-limits to daycare children. Per teacher statements, the elementary school children utilize the storage shed toys. Daycare children have their own separate toys. Teacher-child ratios were observed, and staff names were recorded. Care and supervision were evaluated to determine whether the basic needs of children were met and appropriate.
Health Related Services: Medications are inaccessible to children; all prescription and non-prescription medications have the child’s name and are dated; written consent and instruction from the child’s representative, a plan to document and report to the child’s representative when medication is administered to a child; IMS plan on file (if applicable). Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered only with the parent's written permission (licensing medication form—LIC9221—also used). The parent can bring and take medication home daily. Medication will be properly labeled and stored in its original container.
The parent board was reviewed and has posted all the required forms.
Staff Records/ Children Records: Staff and Children's records were reviewed. LPA verified that at least one staff member with current CPR and First Aid Training is present. All staff complete the Mandated Reporter training every two years. All staff receive the Measles, Pertussis, and Influenza vaccinations.
LPA reviewed 5 children's records, complete with the parent’s signature.
Staffing Ratio and Capacity: Teacher-child ratios were observed, and staff names were recorded. Care and supervision were evaluated to determine if children's basic needs were met and appropriate.
Food Service: The facility provides breakfast, lunch, and snacks. The food is from school cafeteria kitchen. LPA observed the food menu. The kitchen is off limits to preschool children. Cleaning supplies were stored in a closet that is inaccessible to children.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 04/03/2026
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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. 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 child care 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. LPA referred 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)
-LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for and removing any 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.
-This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.
-Facility representative 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.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 04/03/2026
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-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 Karina Gonzales.

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

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC809 (FAS) - (06/04)
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