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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408749
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:18:47 PM


Document Has Been Signed on 09/14/2023 03:18 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:MATHISON FAMILY CHILD CAREFACILITY NUMBER:
197408749
ADMINISTRATOR:MATHISON, CAROLINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 724-1286
CITY:LAKE ELIZABETHSTATE: CAZIP CODE:
93532
CAPACITY:14CENSUS: 2DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Carolina MathisonTIME COMPLETED:
02:00 PM
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On 09/13/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Mathison Child Care Home. Upon arrival, the LPA met with licensee, Carolina Mathison who guided LPA on a tour of the facility. Family members residing in the home include 2 adults (licensee and licensee’s spouse). All adults living in the house have been background cleared. Per Licensee, hours of operation are a day Monday through Friday 6am to 6pm. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 2 day care children and the licensee providing care and supervision. The facility is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a One-story, 3 bedrooms, 2-bathrooms home with a kitchen, living room, dining area, backyard, detached garage and laundry area. 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. There are no cords hanging from the windows. All electrical outlets are covered.

Main Care Area: Main care is provided in the in the living room, dining area and office. Children use the bathroom located on the hallway on the left-hand side. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises. Per licensee, there is a designated area for ill/sick children in the office room (day care area). Children nap in the day care area (living room) in mats that are properly stored when not in use.

Children's bathroom: Children use the bathroom located in the hallway on the left-hand side. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 09/14/2023
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Kitchen/Dining Room: The kitchen does have a physical barrier (Child Safety Gate) and also safety latches installed in the kitchen drawers and cabinets. Sharp items are kept in an upper cabinet. Cleaning compounds are stored in a lower cabinet and the laundry area, made inaccessible by child safety latches. Per licensee, she does not currently have a food program. Meals offered: Breakfast, AM snack, Lunch, PM Snack and Dinner.

Fireplace: There is a fireplace located in the living room that is properly barricaded and screened.

Backyard/Outdoor areas: The backyard is completely fenced (cement block). The backyard is backyard is divided into 4 areas. Backyard is used for day care children. Side yards are for personal use. There are 2 dogs located on the off-limits side of the backyard. There are 3 storages shed that remain locked. Per licensee and LPA’s observations, there are no bodies of water in the premises.

Off-limits: Off-limit areas include all the bedrooms #2 and # bathroom #2, detached garage, and backyard (partially).


Care and Supervision: Licensee is within the ratio for a large facility. The Licensee was reminded that supervision is always required for children in care.

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 was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (3A40BC) reading in Green. Licensee was reminded that fire extinguisher needs to be serviced every year. The facility currently does have childcare insurance.

Medications/ Hazardous Materials: Medications are stored in the master bedroom, made off-limits by the door being locked. Cleaning compounds were observed to be kept in an lower cabinet in the kitchen secured with a safety latch and in the laundry area. LPA observed one fire arm properly locked and stored.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 09/14/2023
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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 records were observed to be complete and current.
Licensee’s CPR/First Aid is maintained current, it expires on 07/2025. Mandated reporter is not current, licensee must submit proof of completing the mandated reporter training by 09/15/2023. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 09/14/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and LIC9227 (Individual Sleeping Plan) and Sleep Log.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe. Applicant was advised that all LIC forms can be found at: www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Mathison 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: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 09/14/2023
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LPA discussed the safe sleep regulations with licensee Mathison and discussed the Child Care Licensing Safe Sleep webpage at 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 www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies have been cited at this time. A notice of site visit was provided 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 Mathison, 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: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4