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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413473
Report Date: 02/16/2023
Date Signed: 02/16/2023 05:52:52 PM


Document Has Been Signed on 02/16/2023 05:52 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:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197413473
ADMINISTRATOR:VAZQUEZ, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 722-0946
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 3DATE:
02/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:56 PM
MET WITH:Patricia Vazquez, Licensee TIME COMPLETED:
06:10 PM
NARRATIVE
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On 02/16/23, Licensing Program Analyst (LPA) Justeene Tamayo and Licensing Program Manager (LPM) Mariela Ramon conducted a case management inspection for the purpose to assess the health and safety of children in care. Upon LPA and LPM arrival, 3 preschool children were present, along with staff #1. The department learned that staff #1 provided inconsistent statements concerning how infant #1 sustained injuries to the hand. Concerning an incident involving infant #1, staff #1 was not forthcoming concerning the incident. On another occasion, staff #1 was shown photographs of the injuries, at which time admitted to being aware of the infant’s injury. Furthermore, staff #1 failed to notify licensee concerning the incident. Facility will be cited a Type A Citation Conduct Inimical 1596.885(c). Please see LIC809-D.

Upon receipt of a Type A deficiency, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

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

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
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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Document Has Been Signed on 02/16/2023 05:52 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: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2023
Section Cited

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Conduct Inimical: child #1 engaged in conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California.

This requirement was not met as evidence by:
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Staff #1 will ensure that in an event of an incident , staff #1 will report incidents to licensee.
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Staff #1 was not forthcoming in how infant #1 sustained injuries which poses an immediate risk to 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) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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