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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412145
Report Date: 11/08/2022
Date Signed: 11/08/2022 01:03:11 PM


Document Has Been Signed on 11/08/2022 01:03 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:VOLK FAMILY CHILD CAREFACILITY NUMBER:
197412145
ADMINISTRATOR:VOLK, KATHLEEN L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 406-0423
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 4DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Kathleen Volk, Licensee TIME COMPLETED:
01:15 PM
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On 11/08/22, Licensing Program Analysts (LPAs) Justeene Tamayo and Annelise Villa met with Licensee, Kathleen Volk, who guided analysts on a tour of the facility for the One Year Required inspection. This is a one story, 3 bedroom, 2 bathroom home with kitchen, family room, living room, laundry room, and garage. There is no pool/spa or body of water on the premises. Upon arrival LPAs observed 3 preschool children and 1 infant in care. Family members residing in the home include 2 adults (licensee, adult son) and no children. Facility operation are Monday-Friday 6AM-6 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the right. Children have access to the living room and dinning room. Off limit areas include all bedrooms, backyard, detached garage and laundry room. 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 (pantry on upper shelf), medicines (bathroom cabinet with safety latch inaccessible to children ) and hazardous items (sharp knives in drawer in kitchen with safety latch) that can pose a danger to children. LPAs observed a barricaded fireplace. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (3A40BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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: VOLK FAMILY CHILD CARE
FACILITY NUMBER: 197412145
VISIT DATE: 11/08/2022
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Fire/Disaster drill is maintained current. Last fire disaster drill was completed on 08/12/2022.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. LPAs observed cleaning supplies under bathroom sink with safety latch. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, snacks and dinner are provided. Naps are provided on mats in the family room. Licensee is a participant in a food program.

Outdoor: The front yard is safe for children. The front yard is completely fenced. There is no body of water. LPAs observed age appropriate toys. Per licensee, there are three pets on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 01/2024. Mandated Reporter expires 01/2024. There are no window cords accessible to children.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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: VOLK FAMILY CHILD CARE
FACILITY NUMBER: 197412145
VISIT DATE: 11/08/2022
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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227) and Emergency Disaster Plan. Licensee stated currently does not have child care insurance.

During children's file review, child #4 was missing proof of immunization's. Facility has been cited a Type B Citation. Please see LIC809-D.

Licensee Volk 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.

LPAs discussed the safe sleep regulations with licensee Volk 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. 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.

A notice of site visit was given 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 Kathleen Volk along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/08/2022 01:03 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: VOLK FAMILY CHILD CARE
FACILITY NUMBER: 197412145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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. LPAs observed child #4 immunization records missing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2022
Plan of Correction
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Licensee will submit proof of completion of immunization records to LPA Tamayo and keep a copy of the records in the child's file.
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: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4