197415184-3-30-2022-12-CC-JDOY-CCZSLG-20220330135818

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415184
Report Date: 03/30/2022
Date Signed: 03/30/2022 01:58:25 PM

Document Has Been Signed on 03/30/2022 01:58 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:	ASCENCIO FAMILY CHILD CARE		FACILITY NUMBER:	197415184
ADMINISTRATOR:	ASCENCIO, EMMA R.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 362-7590
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	14	CENSUS: 8	DATE:	03/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	Emma Espinoza De Ascencio		TIME COMPLETED:	02:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA's) Justin Dorsey and Justeene Tamayo met with Licensee, Emma Espinoza de Ascencio who guided analyst on a tour of the facility for the One Year Required Inspection. This is single story family 3 bedrooms, 2 bathrooms home with living room, dining area, kitchen, family room (day-care room), and attached garage. There is no pool, spa or other bodies of water on the premises. Upon arrival LPA's observed 1 infant and 7 children, as well as licensee's assistant. Physical Plant: Main care is provided in the converted living room and family room. Children use the bathroom in hallway on the left hand side. Children have access to the living room (converted day care area), family room and first bathroom (children's bathroom). Off limit areas include the kitchen, laundry room, all bedrooms, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under the sink), medicines (upper cabinet in kitchen) and hazardous items (sharp knives inaccessible in kitchen drawer) that can pose a danger to children. Per licensee she uses a gate to enclose/barricade the kitchen from children who are present in the home. 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 (2A10BC) 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 family room. Per Licensee there are no weapon/firearms in the home.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ASCENCIO FAMILY CHILD CARE	FACILITY NUMBER: 197415184
	VISIT DATE: 03/30/2022

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The last fire/earthquake drill was completed 03/2022, LPA advised licensee to conduct a disaster drill every six months. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. 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 locked under the kitchen sink with safety latch. No chemicals in the kitchen were observed to be accessible. Breakfast, AM snack, lunch, PM snack and dinner are provided.

Outdoor: The backyard is safe for children. The backyard is completely fenced. The backyard has grass and concrete areas for children to play. LPA's observed the toys in the backyard to be in safe condition. The backyard also has a fenced off-limits area on the right side of the home where one dogs is kept. LPA's also observed another dog in the home.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expires 03/2024. Mandated Reporter was completed on 05/16/2020. Child nap on mats in the main care area (converted living room) and family room.

Documents discussed: Safe Sleep PIN 20-24-CCP

Licensee Espinoza de Ascencio 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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ASCENCIO FAMILY CHILD CARE	FACILITY NUMBER: 197415184
	VISIT DATE: 03/30/2022

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LPA discussed the safe sleep regulations with licensee Espinoza de Ascencio 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 licensee Espinoza de Ascencio 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 licensee Emma Espinoza de Ascencio

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC809 (FAS) - (06/04)

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