<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750206
Report Date: 02/03/2026
Date Signed: 02/03/2026 03:38:22 PM

Document Has Been Signed on 02/03/2026 03:38 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:SUNSHINE DAY CAMP - STEVENSON RANCHFACILITY NUMBER:
197750206
ADMINISTRATOR/
DIRECTOR:		SAMANTHA OTTMANFACILITY TYPE:
860
ADDRESS:25820 CARROLL LNTELEPHONE:
(661) 310-6063
CITY:STEVENSON RANCHSTATE: CAZIP CODE:
91381
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 0DATE:
02/03/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:43 AM
MET WITH:Samanthan Ottman TIME VISIT/
INSPECTION COMPLETED:
03:37 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 February 3, 2026, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility for the purpose of conducting an Annual Random inspection. LPA met with Jaylynn Cadabona, facility representative who granted access. LPA and representative toured the facility inside and outside. LPA observed no day care children in care and one staff. The site supervisor was not available when LPA arrived. At 1:42 PM, the site supervisor arrived. The facility is open from 7:00 to 8:15 AM in the morning and in the afternoon from 2:05-6:00 PM Monday-Friday. All employees 18 years or older that are working or volunteering have a Criminal Record Clearance (DOJ/FBI) and Child Abuse Central Index Clearance and are associated with the facility.
Physical Plant: The required postings were present on a visible parent wall. The sign in/out sheets were digital on an APP. There are four (4) clean and safe classrooms, the telephone service, heating, ventilation, and lighting are adequate. The daily schedule and activities were posted. There are cubbies for children's belongings that are labeled with their names in each classroom. The furniture, books, equipment, toys, and materials were appropriately aged and in good condition. The drinking water is filtered and available inside the classrooms in the form of water jugs and either labeled water cups or disposable cups. Representative stated the water bottles are taken home daily. There is no napping or equipment. First Aid Kit is inside the office in a drawer. There is an Emergency Survival Kit kept in each classroom and supplies are kept in the storage room next to the office. Trash cans have secure lids.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
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)
Page: 2 of 8
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: SUNSHINE DAY CAMP - STEVENSON RANCH
FACILITY NUMBER: 197750206
VISIT DATE: 02/03/2026
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
The temperature inside the room was comfortable. Representative stated, the fire extinguishers, ceiling sprinklers, smoke detectors and carbon monoxide detectors throughout the day care center are all operable and were checked during the last fire inspection. There is a small kitchen with storage cabinets, sink and microwave. Inside the kitchen area there are two restrooms, each with one toilet and one handwashing sink that are functioning properly and at the appropriate height. LPA did not observe any accessible hazards. There was soap, toilet paper, and paper towels available. Representative stated the staff share the same restroom as the children. Representative stated the staff have access to the restrooms inside the main school. The cleaning supplies are kept in a locked cabinet inside one of the bathrooms.
Outside: Outdoor play equipment was inspected for safety, cushioning material, good repair and is age appropriate. LPA observed a large play structure securely anchored in the ground with a canopy for shade and wood chips as a cushioned surface. There was a swing set anchored in the ground and grass area for active play. There were tables/benches for shade and a climbing apparatus. The playground was observed to be free of debris. Drinking water is available in the form of a portable water jug and disposable/labeled cups. Representative stated there are no bodies of water on the premises. LPA did not observe any. The fencing is wrought iron, observed locked and is secure around the entire playground.
Other Review: Children and staff files were reviewed. Current Pediatric CPR/First Aid (expires 9/2027). Representative stated transportation is not provided. Disaster Drills: Fire Drill was conducted: 12/12/25 Earthquake drill was conducted: 1/23/26. Representative stated the last facility fire inspection was conducted: January 2025. The child/parent roster was not complete with all required information. The physician’s names/ numbers were missing from the roster. LPA reviewed and discussed the regulations with the representative. The representative stated they are aware of the reason for the deficiency being cited. Representative stated the children are inspected for illnesses as they arrive. The isolation area for ill children is in the site supervisor's office until the parent can pick up the child. Representative stated, the medications are stored in the office, locked in a lock box. A review of medication policy states that prescription medication is administered only with parent's written permission.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: SUNSHINE DAY CAMP - STEVENSON RANCH
FACILITY NUMBER: 197750206
VISIT DATE: 02/03/2026
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
The management staff administers medication and documents the dosage, date, and time on a log. All medication is properly labeled and stored in its original container. LIC 125 form was discussed with the representative.

The following was discussed with the Representative:
Access the CCLD Licensing website at www.ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates. Report any director or staff changes within ten (10) days. All representatives are responsible for knowing the regulations when providing care. All employees should know their role and responsibilities of being a Mandated Reporter. Training is renewed every two years at: mandatedreporterca.com. All adults 18 years 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.

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


CCP. 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/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers that were constructed before January 1, 2010, to test their water (used for
drinking and food for lead contamination before January 1, 2023, and then every 5 years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: SUNSHINE DAY CAMP - STEVENSON RANCH
FACILITY NUMBER: 197750206
VISIT DATE: 02/03/2026
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
water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Or LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600. Review PUB 515 for information and posting.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities,
providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly
Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important
Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: SUNSHINE DAY CAMP - STEVENSON RANCH
FACILITY NUMBER: 197750206
VISIT DATE: 02/03/2026
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
Reminder: The CCLD On Duty Worker is available: Monday through Friday from 8:00 AM - 5:00 PM, at (661) 202-3318 for questions, information, and unusual incident reporting. Once the incident is reported within twenty-four (24) hours via telephone, follow up with a written report (LIC 624 form) via email to unusualincidentreport@dss.ca.gov or via fax (661) 202-3810 within seven days of reporting.

There is on Type B deficiency cited during this inspection See LIC 809D page attached to this report. There is one Technical Violation issued. See LIC 9102T V page attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit (LIC 9213), this report, and Appeal Rights were given to Samantha Ottman, Facility Representative. 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: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 02/03/2026 03:38 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 02/03/2026 at 03:25 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: SUNSHINE DAY CAMP - STEVENSON RANCH
FACILITY NUMBER: 197750206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.841
§1596.841 Current roster of children provided care in facility required
Each child day care 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.

This requirement was not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in child/parent roster did not have the physician's names and phone numbers for the children in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2026
Plan of Correction
1
2
3
4
I will add the physicians names/numbers for the children to the roster
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Francisco Pedroza
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2026


LIC809 (FAS) - (06/04)
Page: 7 of 8