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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910014
Report Date: 04/05/2023
Date Signed: 04/06/2023 12:03:05 PM


Document Has Been Signed on 04/06/2023 12:03 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:ARREGUIN, GABRIELA FAMILY CHILD CAREFACILITY NUMBER:
153910014
ADMINISTRATOR:ARREGUIN, GABRIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 903-1553
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 11DATE:
04/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Gabriella Arreguin TIME COMPLETED:
02:30 PM
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On 04/05/23 Licensing Program Analyst (LPA) Beneroso met with Licensee, Gabriella Arreguin, who guided analyst on a tour of the facility for an Annual inspection. This is a one story, 4 bedroom, 2 bathroom home with kitchen, dining area, family room, laundry room and garage. Upon arrival, LPA observed 11 children in care and two adults providing care and supervision. Facility operation are Monday-Friday 5:00 AM - 5:00 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the family room. Children use the bathroom in hallway and second bathroom is kept off limits. Children have access to the family room, kitchen, bathroom #1 and backyard. Off limit areas include all bedrooms and laundry room and garage. Off limit bedrooms were observed not to be locked or made inaccessible to children. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kept in lower kitchen cabinet), medicines are kept in the master bedroom bathroom. Safe and age appropriate toys, play equipment and materials were observed.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
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: ARREGUIN, GABRIELA FAMILY CHILD CARE
FACILITY NUMBER: 153910014
VISIT DATE: 04/05/2023
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Outdoor: The backyard is completely fenced (wooden fence) and it is divided by a gate to make it partially inaccessible. LPA inspected and was observed the backyard to be free of hazards, lose or sharp parts and tools. 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.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires on 11/12/2024 Mandated Reporter expires on 03/05/2024. Licensee has the Mandated Reporter certificate current. LPA reminded licensee the mandated reporter training is to be renewed every two years at www.mandatedreporterca.com

Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP and LIC 9227 (Individual Sleeping Plan). Licensee stated she does not currently have childcare insurance.


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

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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: ARREGUIN, GABRIELA FAMILY CHILD CARE
FACILITY NUMBER: 153910014
VISIT DATE: 04/05/2023
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The smoke detector and carbon monoxide detector, Fire Extinguisher (2A40BC) are in operable condition. Per Licensee, no one smokes in the home. Electrical outlets are inaccessible. LPA reminded licensee no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed on the premises. There is a designated area for ill children as necessary in the kitchen area. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone. There is no pool/spa or body of water on the premises. Naps are provided in the main care area in mats. Per licensee, she is part of the food program and provides the following meals: breakfast, lunch, PM snack and dinner.

Fire/disaster drill is maintained current. Last Fire/Disaster Drill was completed on 04/05/2023, Roster complete and maintained current.



Bathroom: LPA observed the bathroom to be clean and in good condition. Toilet and faucet are clean and operable. The bathroom cabinets have safety latches, making it inaccessible to children.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Sharp knives are kept in drawer in the kitchen, secured with a safety latch. Per licensee, she is currently part of a food program.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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: ARREGUIN, GABRIELA FAMILY CHILD CARE
FACILITY NUMBER: 153910014
VISIT DATE: 04/05/2023
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LPA discussed the safe sleep regulations with licensee Arreguin and discussed the Child Care Licensing Safe Sleep web page 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.

The facility was not found to be in compliance per Title 22 regulations, twoType B deficiency will be cited today (please D page with plan of correction).

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Arreguin, 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: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 04/06/2023 12:03 PM - 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: ARREGUIN, GABRIELA FAMILY CHILD CARE
FACILITY NUMBER: 153910014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2023
Plan of Correction
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Licensee will provide LPA Beneroso with proof of an infant sleeping log via email or tex message no later than 04/19/23
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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2023
Plan of Correction
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Licensee will provide LPA Beneroso with proof of the forms LIC9227 completed and signed via email or tex message no later than 04/19/23
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: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5