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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401107
Report Date: 04/06/2022
Date Signed: 04/06/2022 02:05:54 PM


Document Has Been Signed on 04/06/2022 02:05 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



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: 3DATE:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Maribel ManzanoTIME COMPLETED:
12:45 PM
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On 4/6/2022, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1 Year inspection at the Manzano Family Child Care. Upon arrival, the LPA met with the licensee, Marivel Manzano who guided the LPA on a tour of the facility. . Family members residing in the home include 4 adults (licensee, spouse, adult son, daughter in law) and 2 children (grand daughter). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Sunday 7:00 a.m. to 6:30 p.m. There were 3 daycare children and her husband present during this inspection. Incidental Medial Services (IMS) were discussed. Pre licensee, she does not provide Incidental Medial Services at this time.

The Home is set up as follows:
This is a single-story home with 4 bedroom, 3 bathroom home with kitchen/dining room, living room, laundry room, and garage. The garage is used for storage only and no childcare activities are conducted there. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.
Ø Main Area: Main care is provided in the living and family rooms. Children use the bathroom located in the hallway on the left. Children have access to the kitchen/dining room and backyard.
· Living room/Family room: LPA observed age-appropriate toys and furniture for the children. A small table was observed with 2 chairs. Several plastic storage bins were observed in which games and toys are stored for the children. A small play kitchen was located in the area, so children can play. There are games and books on the premises of this facility. Pre licensee, there is no fireplace in the area.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/06/2022
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· Children Bathroom (#1): Children use bathroom #1 on the left side of the entrance. The Bathroom was toured and inspected sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet and drawers. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair.
· Kitchen: Children have access to the kitchen area. Knives are kept in the Pantry. The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children. In the kitchen, all sharp utensils, poisons, and medications are made inaccessible to children with child safety latches on cabinet doors and drawers.
· Backyard: Children play on the right side of the backyard. There is a concrete area for active play. There are no swings or slides. The rear backyard is off-limits to children in care. There is a swing in the rear backyard that is anchored.

Ø Off-limit: Off-limit areas include the home's all 4 bedrooms (key lock), Bathroom #2 and #3, laundry (child safety knob), rear backyard, and the garage.

· Bedrooms (#1, #2, #3, and #4): LPA observed the key lock to make the room inaccessible to the children


· Bathrooms #2 and #3: LPA observed the key lock
· The garage can be accessed through a door in the kitchen. It is used for storage and laundry only.
· Rear Backyard: 1 dog stay in the rear backyard (gated). LPA observed 1 small dog in the area.

Ø Others:


· AC/Heating Unit was observed. AC/Heating Unit is located on the top of the home and is inaccessible to children.
· Bodies of water: Per the licensee, there are No bodies of water in the home.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/06/2022
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· Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (2A10BC) fully charged Date: 3/2022 and located in the kitchen inaccessible to children. It meets standards established by the State Fire Marshall.
· Fireplace: Fireplace is located in the family room with properly screened.
· 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 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.
· Isolation area (Illness): Per licensee, if the child shows signs of illness, he/she will be separated from other children and stay in Living room.
· Medications and cleaning solutions: Medications are kept in the off-limits master bedroom. Cleaning compounds and detergents are kept under the child-locked, off-limits kitchen under the sink and garage.

· Napping: Children nap in playpens, mats, and toddler beds. Pre licensensee, no children are napping.


· Phone service: There is a working landline or cell phone
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· The First Aid kit is located in the key locked closet inaccessible to children. The First Aid Kit was observed complete with supplies and there is no a first aid manual.
· Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license with an expiration date of 08/26/2025. The licensee has valid vehicle insurance with the expiration date 9/27/22 of and vehicle registration dated 12/2/22.
· Weapons or Firearms: Per licensee, there are no firearms at the facility at this time.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/06/2022
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Ø Documentation:

· Child files: LPA reviewed 8 children's records, the records are incomplete and missing forms (LIC 627).
· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (1/2024) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Facility Roster: LPA observed Child Care, Facility Roster. Per Licensing Information System, facility annual fees were current.
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every months; the last drill was documented and conducted on 04/01/2022.
· Immunization: The licensee has the required immunizations. The licensee provided a written statement declining the influenza vaccination.
· Infant Sleeping Plan (LIC 9227): LPA shared the information with the licensee. Per Licensee, there is NO infant (0-12 months) enrolled in the facility.
· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is current.
· Mandated Reporter Training: The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 7/26/23
· Staff Personnel File: No assistant at this time
Ø The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files. LPA shared LIC 311D Forms/Records to keep in your family child care home.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all times.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/06/2022
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ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü The 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
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü Criminal Record Statement: Licensee [or facility representative] 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 the 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.
ü Safe Sleep: LPA discussed the safe sleep regulations with the licensee [or facility representative] 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 the licensee [facility representative] 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 drecommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
ü Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/06/2022
NARRATIVE
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ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü The 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
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü Criminal Record Statement: Licensee [or facility representative] 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 the 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.
ü Safe Sleep: LPA discussed the safe sleep regulations with the licensee [or facility representative] 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 the licensee [facility representative] 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 drecommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
ü Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/06/2022
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ü Type A citation: LPA (name of analyst) informed licensee [or facility representative] (include name) that this report dated (insert visit date) document(s) (number of Type A citation) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA (name of analyst) informed the licensee [or facility representative] to provide a copy of this licensing report dated (insert visit date) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family daycare 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.
ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.govü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

ü LPA provided consultation during the inspection.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with



Title 22 of the California Code of Regulations and/or Health & Safety codes.
Exit interview was conducted and the report was reviewed with the licensee Marivel Manzano.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 04/06/2022 02:05 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA observed the assistant does not have her IZ information, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2022
Plan of Correction
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The licensee will email the report to the LPA.
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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
LIC809 (FAS) - (06/04)
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