197412815-2-17-2023-12-CC-AVIA-CP52S9-20230216163843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412815
Report Date: 02/16/2023
Date Signed: 02/17/2023 08:00:30 AM

Document Has Been Signed on 02/17/2023 08:00 AM - 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:	HONG PARK FAMILY CHILD CARE		FACILITY NUMBER:	197412815
ADMINISTRATOR:	HONG PARK, YOUNG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 803-5119
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91355
CAPACITY:	14	CENSUS: 4	DATE:	02/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Young Hong Park		TIME COMPLETED:	02:45 PM

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On February 16, 2023, Licensing Program Analysts (LPA) Annelise Villa, met with licensee, Young Hong Park, who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPA observed 4 children in care and 2 adults caring for them. Family members residing in the home include Licensee, Licensee’s husband and two adult children. Facility hours of operation are Monday - Friday 9AM- 5PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: This is a two-story family home. The home consists of a kitchen, dining room, living room, family room, three bedrooms, three bathrooms and a garage. The primary care for children is be conducted in the living room. Children use Bathroom #1 located off the family room. The home was inspected inside and out for safety, comfort, cleanliness, orderliness, telephone service (cell phone), heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds and medicines are kept in on a high kitchen counter inaccessible to children in care, sharp knives are kept under the kitchen sink with an operable safety latch and are inaccessible to children). Children nap on cots in the family room.

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) 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

Continued on LIC809-C.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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: HONG PARK FAMILY CHILD CARE	FACILITY NUMBER: 197412815
	VISIT DATE: 02/16/2023

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Bathroom: LPAs observed toilet and faucet are clean and operable. There are no shampoos or cleaning products in bathroom #1.

Kitchen: The kitchen is off limits to daycare children. Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, and snacks are provided. Licensee stated she is not a participant in a food program.

Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall. There are no pets on the premises. LPAs observed age appropriate toys, well secured and safe for children.

Pools/Spas/Bodies of Water: There are no bodies of water in the premises.

Advisory/Other: First Aid kit was observed in the living room with supplies readily available. CPR/First Aid expires 1/2025. Mandated Reporter certificate was unable to be located, however licensee does not remember when she completed the training. LPA reminded licensee mandated reporter training must be completed every 2 years. Licensee will retake Mandated Reporter Training and send certificate of completion to LPA no later than February 17, 2023.

The facility annual fees are current. Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Children files were found to be complete. Fire/Disaster drills are maintained current. Fire disaster was completed on 12/16/2022.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227).

Licensee Hong Park 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.

Continued on LIC 808-C

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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: HONG PARK FAMILY CHILD CARE	FACILITY NUMBER: 197412815
	VISIT DATE: 02/16/2023

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Although Licensee does not have any infants in care, LPA discussed the safe sleep regulations with licensee 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: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

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