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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409928
Report Date: 02/21/2024
Date Signed: 02/21/2024 03:39:31 PM


Document Has Been Signed on 02/21/2024 03:39 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:MONTERROSA FAMILY CHILD CAREFACILITY NUMBER:
197409928
ADMINISTRATOR:MONTERROSA, MILAGROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 285-4803
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 2DATE:
02/21/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Licensee Milagro MonterrosaTIME COMPLETED:
03:50 PM
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On 2/21/2024 at 1:26pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observed 2 children in care and the Licensee providing care and supervision (fingerprint cleared and associated to the facility.)

The operational childcare hours are Monday through Friday varied up to 23 hours depending on family's needs.

This is a one-story family home. There is a living room, classroom, kitchen, three bedrooms, two bathrooms, laundry area in garage, and attached garage but not accessible from inside the home via a safety knob. Licensee does provide napping: 12 cots and 1 crib are available for the children in care. The off-limits areas are the two bedrooms, second bathroom, and garage. Licensee provides breakfast, lunch, dinner, and two snacks. 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. The fireplace is screened, not in use, and barricaded. Hanging window blind cords: The cords are inaccessible to children. Pets: there are no pets on premises. Phone service: There is a working landline and cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does provide transportation for children. Isolation occurs in the first bedroom on the left for children in care showing signs of illness.

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SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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: MONTERROSA FAMILY CHILD CARE
FACILITY NUMBER: 197409928
VISIT DATE: 02/21/2024
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Knives are kept in the kitchen in a high cabinet, inaccessible to children in care with a safety lock. Medication is kept in the kitchen in a high cabinet, inaccessible to children in care with a safety lock. Cleaning supplies and chemicals are kept in the inaccessible garage away from children in care, secured by a safety knob.

There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons, firearms, or ammunition. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer and bandages; however, it was missing tweezers, scissors, gauze, adhesive tape, and cleansing pads/solution was observed to be inaccessible to children kept high in a kitchen cabinet; this is a Type B violation, see the LIC 809D for the details. The required fire extinguisher (2A10BC) is reading in green, last tested on 8/10/2023. Smoke and carbon monoxide detectors were found to be in operable condition, tested at 1:49pm and 1:51pm, respectively. Fire and Disaster drills are conducted at least every six-months, last drills were recorded on 2/14/2024 at 3:45pm.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), Pub 515 Lead Exposure, Pub 269 CA Child Passenger Law, and Earthquake Preparedness Checklist (LIC 9148).

Licensee has insurance coverage for the facility from DC Insurance Services Inc., expiring 12/23/2024.

The Licensee provided proof of immunization against pertussis (TDAP), measles (MMR), TB, and Influenza vaccination for self and TB for their adult son.


Licensee was able to provide a valid CPR/First Aid training valid until 2/2025. Child Care Provider Mandated Reporter Training Certificate has been completed 1/14/2022, expiring 1/2024.

Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, and PM 286-California School Immunization Record.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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: MONTERROSA FAMILY CHILD CARE
FACILITY NUMBER: 197409928
VISIT DATE: 02/21/2024
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Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative 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.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative 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 the 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 recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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: MONTERROSA FAMILY CHILD CARE
FACILITY NUMBER: 197409928
VISIT DATE: 02/21/2024
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-


CCP. 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/.

Facility Representative 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.
The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is not in compliance, a Type B Deficiency has been cited. Please, see the LIC 809D for the citation. An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Facility Representative.

All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/21/2024 03:39 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: MONTERROSA FAMILY CHILD CARE
FACILITY NUMBER: 197409928

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

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 by not having a complete first aid kit missing tweezers, scissors, first aid manual, cleaning pads/solutions, and adhesive tape which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2024
Plan of Correction
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Licensee plans on e-mailing or texting the pictures that they have acquired the missing first aid kit supplies no later than 3/6/2024.
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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