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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750217
Report Date: 02/04/2026
Date Signed: 02/04/2026 02:04:09 PM

Document Has Been Signed on 02/04/2026 02:04 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:SKYLINE ACADEMYFACILITY NUMBER:
197750217
ADMINISTRATOR/
DIRECTOR:		MARIANNE HADDADFACILITY TYPE:
860
ADDRESS:18045 SIERRA HWYTELEPHONE:
(661) 977-0113
CITY:SANTA CLARITASTATE: CAZIP CODE:
91351
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 7DATE:
02/04/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:MariaTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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On February 4, 2026, 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 to the Palmdale Regional Office on January 21, 2026. LPA toured the facility with the representative and observed seven school aged children in care and two staff during the inspection.

On January 23, 2026, LPA conducted an inspection, interviewed relevant parties, and reviewed files. The interviews revealed Child 1 (C1) left the classroom unsupervised and obtained candy with peanuts and gave them to Child 2 (C2) who ate the candy and informed the staff their tongue felt numb. The staff reacted and notified the parent for C2. The staff did not provide supervision to C1 and the staff did not provide emergency medical treatment to C2 who suffered an allergic reaction. Therefore, based on the interviews the lack of supervision and health-related services violations occurred.

There are two Type A violations cited during this inspection. See the 809 D 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.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2026
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: SKYLINE ACADEMY
FACILITY NUMBER: 197750217
VISIT DATE: 02/04/2026
NARRATIVE
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The licensee/representative will obtain a signed acknowledgment of Licensing Reports (LIC 9224) from parent/guardians and place it in each of the children’s files (remain for three years) as there is an immediate risk to the health, safety, or personal rights of the persons in care. 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 Marianne Haddad, 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: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/04/2026 02:04 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 02/04/2026 at 01:48 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: SKYLINE ACADEMY
FACILITY NUMBER: 197750217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2026
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision – 101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...1) No child(ren...the supervision of a teacher at any time...this requirement was not met as evidenced by:
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None of the children will not come into the office and will not share any food and teacher will not allow kids to leave the classroom unsupervised. I provided a letter in the APP that nut free snacks, treats are not to be brought from their child's home to the school.
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Based on interviews C1 obtained candy with peanuts unsupervised and gave the candy to C2 who had an allergic reaction and needed emergency medical treatment which is an immediate health, safety, or personal rights risks to the persons in care.
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Type A
02/05/2026
Section Cited
CCR101226(c)

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101226(c) – Health Related Services (c) The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized representative...illness or injury is such that there should be no delay in getting medical treatment for the child. This requirement was not met as evidenced by:
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I will not wait for parents permission to assist the children I will call 911 or administer the EPI pen.
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Based on interviews and record reviews, C2 suffered an allergic reaction to candy with peanuts given by C1 and the Licensee did not provide emergency medical treatment to C2 which is an immediate health, safety, or personal rights risk to the persons in care.

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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: 02/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2026


LIC809 (FAS) - (06/04)
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