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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153904489
Report Date: 05/03/2023
Date Signed: 06/26/2023 08:34:43 AM


Document Has Been Signed on 06/26/2023 08:34 AM - 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:GUZMAN, NORMA FAMILY CHILD CAREFACILITY NUMBER:
153904489
ADMINISTRATOR:GUZMAN, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 845-8629
CITY:LAMONTSTATE: CAZIP CODE:
93241
CAPACITY:14CENSUS: DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Norma GuzmanTIME COMPLETED:
02:03 PM
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On 05/03/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Guzman Family Child Care Home. Upon arrival, the LPA met with the Licensee, Norma Guzman, who guided the LPA on a tour of the facility. Family members residing in the home include 2 adults (licensee, and her spouse, and two adult sons) and one minor daughter. All adults living in the house have been background cleared.
Per the Licensee, the hours of operation are Monday through Friday, 6:00 AM to 5:00 PM. Per licensee, no overnight care is provided. Upon arrival, LPA observed 5 children in care and one adult providing care and supervision. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a one-story, 4-bedroom, 2-bathroom home with a kitchen, living room, dining area, laundry area, and garage. The garage is off-limits. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows are free of cracks, bugs, and debris.

Main Care Area: Main care is provided in the living groom and bedroom 1 and 2. Children use the bathroom located down the hall to the right. LPA observed age-appropriate toys and furniture for the children. Per licensee, there is a designated area for ill/sick children in one of the rooms.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
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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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: GUZMAN, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153904489
VISIT DATE: 05/03/2023
NARRATIVE
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Children's bathroom: Children use the bathroom down the hallway to the right. The bathroom was clean, sanitized, and in good repair. LPA observed shampoos being removed from the shower. The bathroom was toured and inspected sink and toilet which is in operable condition. Toilet and faucets are clean, safe, and operable.

Kitchen/Dining Room: Children in care have access to the kitchen. LPA observed sharp knives being accessible by a broken safety latch in one of the drawers and also in the counter. A type A citation was issued for this violation. Licensee removed the sharp knives by moving to a higher kitchen cabinet.

Backyard/Outdoor areas: The backyard is completely fenced (with block cement). LPA inspected and was observed the backyard to be free of hazards, lose or sharp parts and tools. There was BBQ pit that needs to be covered or removed. LPA observed appropriate and safe toys in the play area. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises. There is a storage shed that remains locked and inaccessible to children.

Off-limits: Off-limit areas include the master bedroom, bedroom #3, bedroom # 4 and bathroom #2 made inaccessible by doors being locked. The left side of the backyard is made inaccessible by a gate. Laundry room area does not have any cleaning products accessible. The garage is detached from the home and off limits.



Others:
Per licensee and LPA’s observations, there are no bodies of water. Electrical outlets are covered and made inaccessible to children. There are no pets in the facility.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GUZMAN, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153904489
VISIT DATE: 05/03/2023
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Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.
Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit is located in the safety latched closet and was observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. Transportation is not currently offered.
LPA observed a required fire extinguisher (3A40BC) reading in Green and currently serviced.
Per LPA’s observations, there were no hanging window blind cords.
Medications/ Hazardous Materials were observed to be located in the garage and laundry room, inaccessible by safety knob. Medications are in the off-limits kitchen in the pantry, inaccessible by safety knob. Per LPA’s observations, Firearms were stored in compliance with Tittle 22 regulations. The facility currently does have childcare insurance.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The Licensee will not be providing IMS to the children at this time.

Records: Children’s and infant’s records were observed not to be complete and current. One infant in care was missing LIC9227 Individual and Sleep Logs. Two Type B Deficiency were issued for these deficiencies . Licensee’s CPR/First Aid is maintained current. It expires on 09/26/2023. Mandated reporter is also maintained current, it expires on 07/21/2013
Per Licensing Information System, facility annual fees were current; the Licensee was instructed to pay the overdue annual fees. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 03/27/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GUZMAN, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153904489
VISIT DATE: 05/03/2023
NARRATIVE
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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP and LIC 9227 (Individual Sleeping Plan). The Licensee was reminded that supervision is always required for children in care. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Guzman was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Guzman 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 licensee of the importance of checking for 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.

Inspection was conducted in Spanish, LPA is certified as bilingual by the department.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GUZMAN, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153904489
VISIT DATE: 05/03/2023
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The facility was cited 1-Type-A deficiency and 2- Type B Deficiency as of result of the violations in accordance with Title 22 of the California Code of Regulations. Facility was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children currently and newly enrolled at the facility during the next 12 months and facility must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each infant’s file. If these requirements are not met, civil penalties per violation will be assessed.

Exit interview conducted and report was reviewed with the licensee Guzman, along with her appeal rights and Notice of Site Visit.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2023 08:34 AM - It Cannot Be Edited

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: GUZMAN, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153904489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as shark knives were observed to be in the kitchen counter and in a drawer witha broken safety latchwhich poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2023
Plan of Correction
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Licensee removed sharp knives from counter and drawer with broken safety latch in an upper cabinet in the kitchen.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 06/26/2023 08:34 AM - It Cannot Be Edited

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: GUZMAN, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 153904489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above as LPA observed infant's files with no sleep logs which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2023
Plan of Correction
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Licensee will send sleep logs via email or text message as proof of documentation of infant sleep logs to LPA no later than 05/12/23.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above as LPA observed infant's files with no form LIC9227 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2023
Plan of Correction
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Licensee will send picture via email or text of LIC9227 to LPA as proof of keeping the form in the child's file no later than 05/12/23
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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