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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412963
Report Date: 07/18/2019
Date Signed: 07/18/2019 11:09:14 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:ESPINOSA FAMILY CHILD CAREFACILITY NUMBER:
197412963
ADMINISTRATOR:ESPINOSA, LUCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 533-7346
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 9DATE:
07/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Lucy EspinosaTIME COMPLETED:
11:30 AM
NARRATIVE
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On 7/18/2019 at 8:30 a.m., Licensing Program Analyst (LPA) Brianna Reynoso was greeted by above facility’s licensee, Lucy Espinosa. LPA was at the facility to conduct an unannounced random annual inspection. LPA disclosed the purpose of the visit and was granted entry by licensee, who guided LPA on a tour of the facility.

Upon arrival, LPA observed eight children in care.

The facility's hours of operation are Monday through Friday 6:45 a.m. to 7:00 p.m. The licensee provides breakfast, snack, lunch, and dinner, and is currently enrolled in a food program. The licensee conducts pick up and drop off for children who are enrolled in school. There is one pet dog on the premises, which licensee stated is occasionally around the children in care.

This is a two story, three bedroom, three bathroom home with an attached garage. Main care is provided in the family room, downstairs bedroom also known as the infant/toddler room, and the dining area. The children use the bathroom located to the right of the facility entrance. The backyard is used for outside play. The off limit areas include the entire upstairs portion of the home, two of the three bedrooms, two of the three bathrooms, the laundry room, and the attached garage.

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. There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility at this time, nor did the LPA observe any weapons during the inspection. Licensee stores medications in a top shelf inside of the kitchen pantry, and sharp knives are stored in a kitchen cabinet located to the left of the sink.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 197412963
VISIT DATE: 07/18/2019
NARRATIVE
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The outside backyard is used by the children for outside play, and is gated all around. The outdoor play area was inspected and play equipment was observed to be free of hazards, loose, or sharp parts. There were no bodies of water at the family day care home. LPA observed age appropriate toys inside and outside of the home.

The facility’s fire extinguisher (2A10BC) met the State Fire Marshal standards. The service tag on the fire extinguisher (2A10BC) indicated it was last serviced on 2/28/2019. Licensee tested the dual smoke and carbon monoxide detector at 10:43 a.m., and found it to be in operable condition. The facility annual fees are current. The parent board was reviewed and had all of the required forms posted and accessible to parents.

Staff files were reviewed and found to be incomplete. At 10:00 a.m., LPA conducted file reviews for staff members, and found that the licensee did not have proof of immunizations for Staff 2 on file.



The facility roster, children files, and fire drills were up to date, and all individuals living the family child care home have been fingerprinted and associated to the facility. The licensee and her assistant had a current CPR and Pediatric First Aid certification, which expire on 1/05/2021. The licensee also provided LPA with proof of her required immunizations.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 197412963
VISIT DATE: 07/18/2019
NARRATIVE
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The following were discussed:
There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present. Baby walkers, baby jumpers, baby exersaucers, baby bouncers/rockers and any other item that falls into that category are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements. LPA also provided licensee with the new 2019 Safe Sleep in Child Care brochure.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.

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.



The licensee was reminded it is his/her responsibility to visit the departments website to obtain licensing forms, Quarterly Updates, and Provider Information Notices (PINs): www.ccld.ca.gov

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
childcareadvocatesprogram@dss.ca.gov & (916) 654-1541.

The facility was in not compliance per Title 22 regulations, and deficiencies were cited today.

An exit interview was conducted, a copy of this report, notice of site visit, and appeal rights were provided to licensee, Lucy Espinosa.








SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 197412963
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2019
Section Cited
HSC
1597.622(a)(1)
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1597.622 Employees or volunteers at day care center; immunization requirements; records; exemptions (a)(1) 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. Each employee and volunteer shall
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Licensee has stated Staff 2 will provide her with a copy of her required immunizations against measles (MMR), tuberculosis (TB), and Pertussis (Tdap). Proof of the immunizations is to be submitted to LPA Neal via email, no later than the plan of correction due date.
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receive an influenza vaccination between August 1 and December 1 of each year. This requirement was not met as evidenced by: Based on LPA observations. LPA conducted file reviews and found that Staff 2 did not have proof of immunizations of file. This poses a potential risk to the health and safety of children in care.
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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) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4