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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413588
Report Date: 09/24/2019
Date Signed: 09/24/2019 11:11:52 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:MORENO FAMILY CHILD CAREFACILITY NUMBER:
197413588
ADMINISTRATOR:MORENO, MONIQUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 266-1220
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 10DATE:
09/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Monique MorenoTIME COMPLETED:
11:26 AM
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Licensing Program Analyst's (LPAs) Smith and Thompson-Miller met with licensee, Monique Moreno and conducted an unannounced Annual/Random inspection. This is a single story 3 bedroom, 2 bathroom home with kitchen, living room, formal dining room, family room, enclosed patio and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 2 adults (licensee, spouse) and 2 children. There is also 1 small dog. Upon arrival LPA's observed 10 (two infants, eight toddler/preschool) day care children in care. Assistant present during the inspection. Day and hours of operation are Monday through Friday 6:00 AM - 6:00 PM. Incidental Medical Services (IMS) was discussed and per licensee no children are currently receiving IMS.

Child care is provided in family room #1, room #3, living room and backyard play area. Children use the bathroom #1 located next to the child care room. Children have access to the living room and family room (used for school aged children). Off limit areas are bedrooms #1, #2, kitchen (safety gates) and the garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kept in garage), medicines, and hazardous items that can pose a danger to children. Facility roster was observed. Fire/earthquake drills are current. Transportation is provided at the facility by licensee.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 197413588
VISIT DATE: 09/24/2019
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Per licensee, there are no weapons or firearms of any kind in the facility at this time. Knives are made inaccessible in kitchen and kitchen is made off limits by gates. There are age appropriate toys and equipment on the premises. The required fire extinguisher 2A10BC, smoke & carbon monoxide detectors are in operable condition. Licensee Pediatric CPR & First Aid expired 01/2019. The First Aid kit was observed and is complete. Fireplace is blocked to prevent access to children.

The following was discussed with the Licensee:
Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, Safe Sleep and information on shaking baby syndrome. The role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. Licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

Requirements for fingerprint clearances and associations were discussed with the licensee.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 197413588
VISIT DATE: 09/24/2019
NARRATIVE
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Please be mindful of the following safe sleep best practices:

• Always place infants on their backs for sleeping

• Use only a tight-fitting sheet on the crib or play yard mattress

• Do not hang any items from the crib or above the crib

• Keep all items, including blankets, out of the crib or play yard

• Pacifiers may be used as long as they do not have items attached to them

• Infants should not be swaddled or have any items covering them while sleeping

• The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Note: the above guidelines are recommendations for best practices only, until regulations are approved and adopted.

Thank you for all that you do to help keep our children safe.

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 197413588
VISIT DATE: 09/24/2019
NARRATIVE
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Licensee advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit written report within 7 days) and on the form LIC624B. Pamphlet Information regarding Safe Sleep Awareness Campaign (PIN 19-02-CCP) and Safe Sleep Regulation Concepts, Quarterly Update Summer 2019, Teaching Pyramid (But What Do I Do When He Hits? and Challenging Behavior and Supporting Infant and Toddler's Social Emotional Development). The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

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

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

Licensee was cited Type B deficiency(ies), according to California Code of Regulations Title 22 See 809D report for deficiencies.. Exit interview was conducted, report was read and a copy of the report was given to Licensee.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 197413588
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2019
Section Cited

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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This requirement was not met as evidenced by: LPA observed Licensee and staff without current CPR/First AId certificate.
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Type B
10/24/2019
Section Cited

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At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06).

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This was not met as evidenced by: LPA reviedwed 3 file which were missing LIC995A and blue immunization card.
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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: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5