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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750211
Report Date: 06/04/2025
Date Signed: 02/09/2026 12:57:52 PM

Document Has Been Signed on 02/09/2026 12:57 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:NOAH'S PARK B PRESCHOOLFACILITY NUMBER:
197750211
ADMINISTRATOR/
DIRECTOR:		SCOTT JETTEFACILITY TYPE:
860
ADDRESS:27927 SMYTH DRIVETELEPHONE:
(661) 505-3583
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: DATE:
06/04/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:36 AM
MET WITH:Heather JohnsonTIME VISIT/
INSPECTION COMPLETED:
12:00 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
THIS REPORT IS AMENDED FROM ORIGINAL DATED 6/4/25 TO ADD TYPE A LANGUAGE AND ADD INJURY DESCRIPTION

On June 4, 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 on to the Palmdale Regional Office on May 2, 2025. LPA toured the facility with the representative and observed twenty-three preschool children in active care with five staff.

On May 2, 2025, the reported information involved Staff observing a Child 1 (C1) on the play yard and tried to retrieve a bean bag out of reach. C1 got on top of a bicycle and fell and put their hand out to catch themselves and fell and broke their wrist. Parents arrived and took C1 to the doctor where a brace and cast were needed.

LPA conducted interviews with the relevant parties. LPA reviewed children’s files and completed a safety inspection of the playground. LPA observed the area of the playground where C1 climbed, and it was an open play area with concrete flooring and a roof with shingles over the classrooms. There was a large play structure in the middle of the room with rubber mat as a cushioned surface. Per staff, they observed C1 playing on the playground with the bean bags and other children were throwing the bean bags on the roof. Per Staff, they turned their back and walked away a few feet to tend to other children in a different area of the playground. Per staff, they did not observe C1 climb onto a small bicycle to retrieve the bean bags overhead on the roof and responded once C1 fell and began to cry.

Based on interviews, and record review, it was determined that staff did not always have visual supervision of C1 which resulted in C1 being able to climb on an unsafe object, fall, and injure themselves.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2025
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 4
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NOAH'S PARK B PRESCHOOL
FACILITY NUMBER: 197750211
VISIT DATE: 06/04/2025
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
THIS PAGE IS AMENDED FROM ORIGINAL REPORT DATED 6/4/25 TO ADD TYPE A LANGUAGE

Based on observation, the playground was secure and locked. Although the staff took appropriate action, the care and supervision violation did occur.

There is one Type A deficiency cited during this inspection for Responsibility of Providing Care and Supervision. See the LIC 809D page attached to this report.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeal Rights were provided to Heather Johnson, Facility 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: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/04/2025 12:02 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 06/04/2025 at 11:34 AM
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: NOAH'S PARK B PRESCHOOL
FACILITY NUMBER: 197750211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2025
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision(a) The licensee shall provide care and supervision as necessary....(1)No child(ren) shall be left without the supervision of a teacher at any time....Supervision shall include visual observation. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Per facility representative, I will provide training to the staff and conversations with each staff member in regard to their placement and supervision on the play yard to always be completely visible to each child. I will provide proof of the training to Licensing once it is completed.
8
9
10
11
12
13
14
Based on interviews and record reviews Staff observed Child 1 (C1) playing with the bean bags on the playground other kids threw the bean bags on the roof and Staff walked away to tend to other children in a different area of the playground. Staff did not observe C1 climb onto a bicycle trying to retrieve the bean bags off the roof and C1 fell from the bicycle and injured their wrist which is an immediate health, safety, or personal rights risk to the children in care,
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4