197409384-10-19-2023-12-CC-MRIA-CWRT8V-20231019143058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409384
Report Date: 10/19/2023
Date Signed: 10/19/2023 02:31:18 PM

Document Has Been Signed on 10/19/2023 02:31 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	SANTANA FAMILY CHILD CARE		FACILITY NUMBER:	197409384
ADMINISTRATOR:	SANTANA, MARTA L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 367-5632
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	14	CENSUS: 5	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Martha Santana, Licensee		TIME COMPLETED:	02:40 PM

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On Thursday, October 19, 2023, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with licensee Martha Santana who guided LPA Rivera on a tour of the facility.

Family members residing in the home and staff have been discussed with licensee and are cleared. LPA observed 2 infants and 3 preschool children present with licensee and staff #1. Operating hours are Monday to Friday from 6:00 a.m. to 6:00 p.m. and care for children ages 0 to 13 years old.

This facility is a one-story home that consists of 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, bonus room (converted outdoor patio) and front and backyard fenced.

Areas off limits to children include- 3 bedrooms (child proof round ball on doorknobs), 1 bathroom (bonus room), kitchen, bonus room and front yard. Areas accessible to children include living room, dining room, restroom located in the hallway and backyard.

At approximately 10:20 a.m., LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and landline). For ventilation, LPA Rivera observed central AC and the vents located on the ceiling and ceiling fans. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA observed an electric fireplace with a fireproof screen cover. LPA observed 2 play pens and observed to be free from bumper pads, blankets, pillows and hanging items.

LPA Rivera observed cleaning compounds items, stored underneath the kitchen sink cabinet and observed a gate barrier installed between kitchen and living room and dining room and kitchen making it inaccessible for children to enter kitchen. LPA observed the knives and sharp objects stored inside the kitchen drawer. LPA Rivera informed licensee to add another barrier to the sink cabinet and drawer.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SANTANA FAMILY CHILD CARE	FACILITY NUMBER: 197409384
	VISIT DATE: 10/19/2023

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For water drinking, licensee stated she provides filtered water and refills children’s sippy cups. The licensee stated the facility provides breakfast, a.m snack, lunch and p.m. snack. LPA informed licensee any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. Licensee stated she currently does not have any children with severe food allergies nor on medication.

At approximately 10:29 a.m., LPA Rivera entered the bathroom and observed the toilet, hand washing sink, hand soap and paper towels. LPA observed the bottom sink cabinet closed and did not observe hazard materials and observed the restroom to be in good condition. LPA reminded licensee any personal items, need to be made inaccessible to children.

LPA Rivera asked the licensee if there were any pets, poisons, firearms, weapons, or bodies of water. The licensee stated she has no pets, no poisons and no bodies of water, no firearms, and no weapons. LPA did not observe pets, poisons, firearms, weapons, nor bodies of water. The license was informed that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

At approximately 10:35 a.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the bonus room and the valve on the green area indicating fully charged and serviced on 3/29/23. LPA observed carbon monoxide detector and smoke alarm located in the bonus room. LPA tested the carbon monoxide and smoke alarm. LPA Rivera heard the sound for the smoke alarm and observed the green light flash for the carbon monoxide. Tester is silent. Detectors are operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the bonus room. For ill isolation, licensee stated she utilizes a corner of the living room. LPA observed the last emergency drill conducted on 4/15/23. LPA reminded licensee the drills are to be conducted every 6 months.

At approximately 10:43 a.m., LPA Rivera inspected the play outdoor (backyard) area that is utilized by children for safety, comfort, and cleanliness. LPA observed the backyard to be fenced and gates closed and with a keypad lock and side latch. LPA observed the play equipment to be age appropriate and in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SANTANA FAMILY CHILD CARE	FACILITY NUMBER: 197409384
	VISIT DATE: 10/19/2023

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safe condition and is free of hazards. For outdoor water drinking, children bring out their water bottles.LPA observed another layer of a fenced barrier mid yard to prevent children access to the off limit area.

LPA Rivera observed licensee American Heart Association Pediatric First Aid/ CPR certification dated 3/16/22 and licensee has proof of immunization against Pertussis, MMR and Influenza declination. Licensee has completed the Child Abuse Mandated Reporter (AB 1207) training dated 2/17/22. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA observed the license, LIC 610A Emergency Disaster Plan, and Pub 394 Notification of Parents Rights, LPA also reviewed children’s roster, children files and staff file. LPA did not observe 15 minute sleep logs. LPA reminded licensee the 15 minutes sleep logs need to be completed for infants under the age of 2 daily when napping.

The following was also discussed with the licensee:

1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SANTANA FAMILY CHILD CARE	FACILITY NUMBER: 197409384
	VISIT DATE: 10/19/2023

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7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

10. Children and staff records must be maintained and updated as needed and be available for review by the Department.

11. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunization's.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

16. Dog(s) and/or pets are recommended to be isolated from children in care.

17. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SANTANA FAMILY CHILD CARE	FACILITY NUMBER: 197409384
	VISIT DATE: 10/19/2023

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For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee Martha Santana was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Martha Santana and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Martha Santana 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee Martha Santana was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The licensee Martha Santana confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During this visit a TYPE B was given for Title 22 102425(j)(2). Please see attached 809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Martha Santana.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/19/2023 02:31 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SANTANA FAMILY CHILD CARE	FACILITY NUMBER: 197409384
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in not completing the 15 min safe sleep log which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/17/2023
	Plan of Correction
1 2 3 4	Per licensee, will start documenting the safe sleep logs. During this visit, licensee begin completing sleep log.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lady King	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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