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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153805521
Report Date: 02/26/2020
Date Signed: 02/27/2020 06:28:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MARIA'S CHILD CAREFACILITY NUMBER:
153805521
ADMINISTRATOR:LOPEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 390-4053
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 4DATE:
02/26/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Maria LopezTIME COMPLETED:
03:27 PM
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 On 02/26/2020, at 12:43 PM Licensing Program Analysts (LPAs) Esequiel Rodriguez and LPA Nadia Flores made an unannounced Required inspection at the Maria's Child Care home facility. The purpose for the inspection is to inspect the facility to ensure the facility meets licensing requirements set forth by Title 22 and statutory requirements. The LPAs met with Licensee, Maria Lopez and Ref-1 stated the purpose for the inspection.

Ms. Lopez provided copy of Current Children in the Home roster. Posted on a prominent place of the facility is the parent's board. It contains all the required items such as License, Roster and Child Care Drill Log for Emergency/Disaster Preparedness, Emergency Disaster Plan (610A); Earthquake Preparedness Checklist (LIC9148); Department's Complaint hotline; Notification of Parent's Rights, (Pub 394) Per Licensee, emergency drills are conducted every three months or sooner.

At the time of the inspection there were four children in care. Per licensee, she is the primary caregiver and is present in the home more than 80% of the operating hours. The facility operating hours are Monday thru Saturday 05:00AM to 05:00PM and when children are present, they are directly supervised at all times.

At 09:39 AM the LPAs along with Ref-1 conducted an inspection tour of the inside and out of the facility's physical plant. Per Licensee, there has been no physical plant changes since the last inspection conducted on 01/24/19. Living in the home are Ref-1 and Ref-2. See LIC 811, Confidential Name form dated 02/26/20.



This home is single story family home. There is a living room, dining room, kitchen, three bedrooms two full bathrooms. The main day care area is in the back of the home including the living room area. There is a studio area in the back of the home, a bird and rabbit cage.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARIA'S CHILD CARE
FACILITY NUMBER: 153805521
VISIT DATE: 02/26/2020
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Per Licensee, there are no fire arms or any thing that can be considered as weapon in the facility Physical plant. The carbon monoxide, fire extinguisher and smoke detectors are present, are fully operational, and meet State Fire Marshall standards. The fire extinguisher is a 2A10BC and is accessible in case of emergencies. Electrical outlets are properly covered. The home has a working telephone. The First Aid Kit is available and complete, but inaccessible to children. There is no fireplace available in the home. All off limit areas are secure with approved child safety protective devices.

The outdoor play area of the day care includes the back yard area, and is properly fenced. The area is free of defects or dangerous conditions, and is clean and safe. Also, the toys use by the children are safe, clean and appropriate. There were no baby walkers, bouncers, jumpers and/or similar items present. Napping equipment (mats) on the premises met regulatory requirements. Per licensee children nap in the designated room/Living room. Outdoor play area is fenced. The front yard is properly maintained. The home has several pets present (a dog, cat, rabbits, birds and a turtle)

The kitchen area is properly secure and inaccessible to children, including cabinet drawers.

The off-limits areas are the rooms, storage areas, the outside studio, and front yard. LPAs advise Licensee that Community Care Licensing (CCL) must be contacted prior to changing off-limits rooms/areas in the house. Storage areas used for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored are inaccessible to children.

The facility is clean, orderly, safe and sanitary, in good repair and with appropriate heating and ventilation.

Per Licensee, when a child has a contagious or symptoms of contagious disease, the child is not accepted for care. However, if the symptoms are noted after the child parents leave the facility, the child is immediately separated from others, and the parents or legal guardian are immediately notified. The home has an isolation area for sick children. There is an area of the home where children who are not feeling well are placed while they wait for their parents to pick them up.



SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARIA'S CHILD CARE
FACILITY NUMBER: 153805521
VISIT DATE: 02/26/2020
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The day care home provides lunch, snack throughout the day, and dinner as needed. The food is also inspected, in an ongoing basis, by the United States Department of Agriculture (USDA). Food brought by parents is labeled with the child’s name and properly stored. (i.e. If a child brings their lunch from home, the lunch box/bag and thermos are labeled with the child’s name.)

The Licensee and assistant have a current Pediatric CPR/First Aid, and has attended the required Mandated Reporter training. The facility is currently working on a more comprehensive plan for Earthquakes, Fire emergency, and floods. The facility annual fees are current.



Licensees provided proof of immunization against pertussis (TDAP), measles (MMR), and Influenza. All adults living in the home have current (TB) Tuberculosis clearance/assessment. Proof of Preventive Health Practices, including 1 hour on Childhood Nutrition was provided.

The Licensee as well as her assistance have a current Mandated Reported Certificate and Pediatric First Aid/CPR cards.

The children files were inspected for the following: Parent Additional Children in Care (LIC 9150); Affidavit Regarding Liability Insurance (LIC 282) This facility has liability insurance; Consent for Medical Treatment (LIC 627); Consent/Verification for Nebulizer Care (LIC 9166) - if applicable; Identification and Emergency Information (LIC 700); Notification of Parents' Rights (LIC 995A) - This form must be given to each parent at the time a child is accepted for care, along with the LIC 995E - Bottom portion keep on file; Caregiver Background Check Process (LIC 995E); Family Child Care Consumer Awareness Information (LIC 9212); California School Immunization Record. Licensee has a blue form on file. However, is not the PM 286. Current "blue" form was provided to licensee. Current form can be downloaded from the following website:http://www.dhs.ca.gov/publications/forms/immunization.htm but must be printed on blue paper only; and Incident reports LIC 624B.

Personnel Records were reviewed for the following: Unusual Incident/Injury Report (LIC 624B)
licensing office when reporting any incidents or injuries occurring during day care hours.
Child Care Facility Roster (LIC 9040); Notice of Employee Rights (LIC 9052); Statement Acknowledging
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARIA'S CHILD CARE
FACILITY NUMBER: 153805521
VISIT DATE: 02/26/2020
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Requirement to Report Suspected Child Abuse (LIC 9108); Property Owner/Landlord Consent Form (LIC 9149), Property Owner/Landlord Notification Form (LIC 9151), and deed or lease/rental agreement are not applicable. Licensee owns the home and has mortgage proof documentation on file. The Licensee has proof of completion of 16 hours of Preventive Health and Safety Training before a license can be issued. The training include Pediatric Cardiopulmonary Resuscitation (CPR), Pediatric First Aid, Preventive Health Practices, and one hour of Pediatric Nutrition.
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A review of the facility associations against Facility Report Summary (LIS 536) dated 02/23/2020 indicates that the licensee, and other individuals who require caregiver background checks have received DOJ, FBI criminal record and child abuse index check clearances or exemptions.

Smoking in the facility premises is prohibited, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are not permitted in the facility. The LPA also LPAs reminded Licensee that the required mandated reported training and shall be renew every two years. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was also discussed. LPA Rodriguez informed licensee that when any IMS is provided, a Plan for Providing IMS must be submitted to the Department for approval.

The following information regarding American with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line is (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA is available at http://www.ada.gov/childqanda.htm. LPAs remind Licensee that she shall continue to familiarize with the guidelines established by the American Academy of Pediatrics to help reduce the risk of Sudden Infant Death
Syndrome (SIDS) when caring for infants. Also, explained that Unusual Incident Reporting Requirements such the Licensee is required to file an Unusual Incident Report when any of the following situations occur:
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARIA'S CHILD CARE
FACILITY NUMBER: 153805521
VISIT DATE: 02/26/2020
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An injury to a child in care, requiring professional medical attention. A missing child. Death of a child. Explosions, fires or other physical damage to the home. It must also subsequently be reported to the local fire authority within 24 hours. Medical Epidemics. Poisonings.

Also advise Licensee to sign up for CCL Quarterly Updates by emailing the Child Care Advocates at
childcareadvocatesprogram@dss.ca.gov or by calling (916) 654-1541 Licensee was informed the Palmdale Regional Office can be contacted for information at (661) 202-3318 Monday through Friday from 8:00 AM - 5:00 PM.

At the time of this inspection, the facility was in compliance per Title 22 regulations, and no deficiencies cited. LPA Rodriguez provided additional consultation regarding Title 22 requirements.

The Licensee agree to mail to CCL (no later than March 13, 2020) copy of the following updated documents: LIC 999, Facility Sketch (floor plan for the outside and inside); LIC 508, Criminal Record Statement; LIC 9052, Notice of Employee Rights; LIC 9108. Statement Acknowledging Child Abuse Reporting; Mandated Reporter Certificate; Control of Property (Property Ownership, copy of deed or property tax statement); TB clearance; pediatric 1st Aid/CPR; Emergency Disaster Plan, LIC 610A; LIC 9148, Earthquake Preparedness Checklist; proof of completion of Preventive Health Practices..

Exit interview conducted and a copy of this Report, LIC 811 as well as the Notice of Site visit (LIC 9213) was provided to Ms. Lopez.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
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