197411223-6-2-2023-12-CC-AALH-CSETUW-20230602150302

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197411223
Report Date: 06/02/2023
Date Signed: 06/02/2023 03:03:10 PM

Document Has Been Signed on 06/02/2023 03:03 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:	HICKS-DORRIS FAMILY CHILD CARE		FACILITY NUMBER:	197411223
ADMINISTRATOR:	HICKS-DORRIS, LINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 272-1488
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 0	DATE:	06/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee Hicks-Dorris Linda		TIME COMPLETED:	03:40 PM

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On 06/02/2023 Licensing Program Analyst (LPA) Alemoh, met with licensee, Linda Hicks-Dorris who guided analyst on a tour of the facility for the One Year Required inspection. This is a two-story home with 5 bedrooms and 3 bathrooms. LPA observed the safety gate barricading the stairway. Upon arrival LPA observed 0 children in care. Family members residing in the home include 3 adults (licensee, licensee two older children). Facility hours of operation are Monday - Friday 6:30AM- 6 PM. Incidental Medical Services (IMS) policy was discussed.

There are no bodies of water in the premises.

Physical Plant: Main care is provided in the front room. There are cubbies for children to place the belongings. Sign in and out sheets were observed. Age appropriate toys and play equipment was observed. There is a classroom area for the children to learn and play. Curriculum books where observed for each child containing coloring, folding, cutting, writing, learning different languages and many more. Water bottles are provided for the children to drink. The children use the bathroom located in the hallway to the left. The off-limits areas are all upstairs, all bedrooms, two restrooms and kitchen. Laundry room and garage are also off limits and are kept locked during business hours.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

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: HICKS-DORRIS FAMILY CHILD CARE	FACILITY NUMBER: 197411223
	VISIT DATE: 06/02/2023

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The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept in the kitchen pantry with a safety door knob. Hazardous items (sharp knives are kept in the kitchen in the upper cabinet high enough that they are inaccessible to children) .

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (3A40BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the living room. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 05/10/2023. LPA observed the fireplace to be screened in the classroom area.

Bathroom: LPA observed the toilet and faucet are clean and operable. The shower/tub were free of prohibited items. LPA did not see any prohibited items in the bathroom.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Tooth brushes are provided for the children to clean their teeth after every meal. Cleaning supplies are in the kitchen pantry which is locked during business hours. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently is on Ventura Food Program. Naps are provided on mats in the front room or the classroom.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

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: HICKS-DORRIS FAMILY CHILD CARE	FACILITY NUMBER: 197411223
	VISIT DATE: 06/02/2023

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Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall and iron fence. No animals on the premises. There is a play structure in the backyard that is age appropriate for children. AC unit was observed to be covered. LPA observed age appropriate toys, well secured and safe for children.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 05/25. Mandated Reporter has expired. LPA reminded licensee; mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have child care insurance.

Licensee Linda 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.

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

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC809 (FAS) - (06/04)

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