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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414356
Report Date: 04/14/2022
Date Signed: 04/14/2022 12:31:35 PM


Document Has Been Signed on 04/14/2022 12:31 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:SIGUENZA FAMILY CHILD CAREFACILITY NUMBER:
197414356
ADMINISTRATOR:SIGUENZA, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 533-3188
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 2DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Evangelina SiguenzaTIME COMPLETED:
12:46 PM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee Evangelina Siguenza and Co-owner Erica Flores, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story, 5 bedroom, 3 bathroom home with kitchen, dining room, living room, family room, laundry room and garage. There is no pool on the premises. Upon arrival LPA observed 2 children with the licensee.

Physical Plant: Main care is provided in the converted living room and connecting dining room. Children use the bathroom in hallway near the on-limits bedroom (nap room). Children have access to the main care area (living room and dining room), family room, and on limit bedroom. Off limit areas include the entire upstairs (4 bedrooms and 2 bathrooms), kitchen, laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible in garage and under sink), medicines (top shelf locked in the laundry room) and hazardous items (locked in pantry) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (3A10BC) 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 in the on-limits bedroom. Per Licensee there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 03/04/22. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
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 2


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: SIGUENZA FAMILY CHILD CARE
FACILITY NUMBER: 197414356
VISIT DATE: 04/14/2022
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Kitchen: Sharp utensils are inaccessible. Breakfast, AM snack, lunch, PM snack, dinner and another snack if necessary are provided to the children. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are kept under the sink and in the garage. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children The backyard is completely fenced. The backyard has grass and a concrete areas for children to play. LPA observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. The licensee CPR/First Aid is up to date and expires 08/22. Mandated Reporter was completed 03/02/22. Children nap on mats and cribs in the on-limits downstairs bedroom.

Documents discussed: Safe Sleep PIN 20-24-CCP.

Co-Owner Flores 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.

LPA discussed the safe sleep regulations with Co-Owner Flores 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. LPA also informed Co-Owner Flores 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 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 Co-Owner Erica Flores.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2