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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401107
Report Date: 07/24/2019
Date Signed: 07/25/2019 01:21:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:MANZANO FAMILY DAY CAREFACILITY NUMBER:
197401107
ADMINISTRATOR:MANZANO, MARIVELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 349-6242
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 7DATE:
07/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Marivel ManzanoTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Neal met with licensee, Marivel Manzano for the purpose of a Random inspection. This is a single story 4 bedroom, 3 bathroom home with kitchen/dining room, living room, backyard, laundry room, and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 3 adults (licensee, son, daughter-in-law) and 1 child (grandchild). There were 7 child care children present during this inspection. Incidental Medical Services (IMS) policy was discussed.
Main care is provided in the living and family room. Children use the bathroom located down the hallway on the left. Off limit areas include the all 4 bedrooms (key lock), the other 2 bathrooms, laundry, the gated rear portion of the backyard and the garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Medicines are kept in an upper cabinet in the hallway inaccessible to children. Sharp knives are in the kitchen pantry in a butcher block. Cleaning compounds and detergents are stored in the garage and in the kitchen above the microwave, inaccessible to children. Facility roster was observed. Licensee has 2 small dogs.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 07/24/2019
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Children play in the backyard on the right side of the home. There is a concrete area for active play and age appropriate toys. There are padlocked gates on both sides of the play area. The off-limits portion of the backyard are separated by padlocked gate. There is no pool or spa on the premises.
Per licensee, there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons. LPA observed age appropriate toys and equipment on the premises. The required fire extinguisher (2A10BC), carbon monoxide detector and smoke detector are in operable condition. Fireplace is properly screened. Home has central AC and heat. Licensee's CPR/First Aid expires 10/28/2019. Licensee has a First Aid kit. LPA observed required documents are posted. A sample of children's files were reviewed. Licensee was reminded that Mandated Reporter training for child care must be completed by licensee and any adults assisting at the child care at the website, www.mandatedreporterca.com, every 2 years.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family child care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 07/24/2019
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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.

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 following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

No deficiencies were cited during this inspection.
Exit interview was conducted and a copy of report was read and provided to Licensee on this date.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
LIC809 (FAS) - (06/04)
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