<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415591
Report Date: 03/22/2023
Date Signed: 03/22/2023 02:25:08 PM


Document Has Been Signed on 03/22/2023 02:25 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:POWELL FAMILY CHILD CAREFACILITY NUMBER:
197415591
ADMINISTRATOR:POWELL, ANTOINETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 802-6841
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 7DATE:
03/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee Powell AntoinetteTIME COMPLETED:
02:50 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
On 03/22/23 Licensing Program Analyst (LPA) Andrew Alemoh, met with licensee, Powell Antoinette who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story home with 5 bedrooms 3.5 bathrooms. (LPA observed a doorway that is locked making access to the stairs, as well as other off-limit areas of the house inaccessible to day-care children) Upon arrival LPA observed 7 children in care (3 infants) and 2 adults caring for them (licensee and assistant #1). Family members residing in the home include 1 adult (licensee, and licensee minor daughter). Facility hours of operation are Monday - Friday 7AM- 5PM. Incidental Medical Services (IMS) policy was discussed.

There is an above ground pool on the premises that is currently being renovated in the backyard. There is also a garage that is currently being converted into a day-care room.

Physical Plant: Main care is provided in the playroom #1 on the left and #2 on the right. There are two baby gates separating the playrooms. The children use the bathroom located in the hallway to the left. The off-limits areas are all upstairs two bedrooms, one restrooms, kitchen, family room, dinning area. Laundry room and converted garage are also off limits and are kept locked during business hours. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept in the top cabinet in the hallway, (no medications) and hazardous items (sharp knives are kept in the off-limits kitchen pantry high enough that they are inaccessible to children.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: POWELL FAMILY CHILD CARE
FACILITY NUMBER: 197415591
VISIT DATE: 03/22/2023
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
26
27
28
29
30
31
32
Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No 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 playrooms. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 03/08/23.

Bathroom: LPA observed the children's bathroom to clean and orderly. There is no shower. Toilet and faucet are clean and in operable conditions.

Kitchen(Off-limits): Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the hallway cabinet high enough making it inaccessible to children. Breakfast, lunch, snacks are provided. Licensee stated she currently does not have a food program. Naps are provided on mats and cribs in playroom #1 and #2.

Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall. LPA observed a 6 ft high fence barricading the renovated above ground pool. Per licensee the reason she put the 6ft fence around the pool is to make it inaccessible and off-limits to day care children. LPA measured the black mesh fence surrounding the above ground pool to be 5ft in height. There is a locking mechanism on the top part of the opening gate. Licensee pulled the lock upwards and the gate opened away from the pool. LPA observed age appropriate toys, well secured and safe for children. There is a second play yard for day care children.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: POWELL FAMILY CHILD CARE
FACILITY NUMBER: 197415591
VISIT DATE: 03/22/2023
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
26
27
28
29
30
31
32
 There is an above ground swimming pool currently being renovated in the backyard. The bodies of water are completely enclosed by a 5 ft mesh fence as well as a 6ft fence. The black mesh fence runs all the way down to the concrete on which it sits, leaving no room between the bottom of the fence and the concrete. The pool gate does not self close or self latch. LPA observed the gate to be a manually closing gate. The lever to open the gate is located at the top of the gate. The gate locking mechanism is located within 6 inches from the top of the gate. The pool gate opens away from the body of water. All items rendering the fence climbable are moved away from the fence. The mesh fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. Per licensee the pool renovation will possibly be completed by the summer time. LPA took photos to document in the file.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 10/21/23. Mandated Reporter expires on 01/21/25. LPA reminded licensee; mandated reporter training must be completed every 2 years. LPA observed the fireplace to be screened.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). LPA observed the infant safe sleep chart within the child records, as well individual sleeping plans. Licensee currently does have child care insurance.

Licensee Antoninette 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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: POWELL FAMILY CHILD CARE
FACILITY NUMBER: 197415591
VISIT DATE: 03/22/2023
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
26
27
28
29
30
31
32
An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4