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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415632
Report Date: 01/17/2020
Date Signed: 01/17/2020 10:46:23 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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
197415632
ADMINISTRATOR:DIAZ, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 233-2441
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 5DATE:
01/17/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Pamela DiazTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Victoria Hunt met with licensee Pamela Diaz who guided analyst on a tour of the facility for an annual random inspection. During the time of this inspection licensee had five children in care. Children were observed to be actively playing in the playroom. There were 3 children under the age of 2 years old, 2 children between the ages of 4 to 5 years observed to be on the premises. Residing in the home includes: adult (licensee), and her spouse. Per LIS, facility annual fees are current. Licensee was operating facility within ratio during the time of inspection. Licensee's assistant arrived shortly into the inspection. Licensee was observed providing adequate supervision during the inspection. This facility operates from less than 24 hours Monday- Sunday.

This home was inspected as follows: Living room, family room, kitchen and dining room, formal dining area, garage, and laundry room.

This home consist of a two story 4 bedroom, 3 bathroom home with kitchen and dining, living room, formal dining room, laundry room, family room, and garage. LPA inspected the facility in accordance to the facility sketch. Main care is conducted in room#1, (den/office room, near the main door entrance), and room #2 (downstairs bedroom), child also have access to the kitchen dining area.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 01/17/2020
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In room #1, LPA observed age appropriate toys and furniture for the children to play with there books and learning activities provided for the children. A security gate was observed that separates room #1 from the formal dining room area.

In room 2, (playroom, downstair bedroom) cubbies were observed in which children can store their belongings. Each cubby was personalized with a child's name on it. This room was observed to have, games, books and toys stored on the shelves. There was a small couch for the children to sit on. The toys observed in the room were in good condition and free of cracks.

There is a bathroom located near room #2, in which the children utilize. The bathroom was observed to be free and clear of hazardous items. The bathroom was observed to have working toilet, sink, and an ample supply of paper towels and soap accessible for the children to use. Lower cabinets were observed to toilet paper. The bathroom was clean, sanitized and in good repair.

There is a security gate that separates the living room from the kitchen/dining room area. The living room was observed to have a fireplace. The fireplace was screened, a metal gate surrounds the fireplace. The fireplace is inaccessible to children.

The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children. The kitchen sink cabinet was secured by a child proof latch, that was in good condition during the time of the inspection. All cabinets in the kitchen were inspected and are free of hazardous and dangerous items. Licensee keeps knives and other sharp objects such as (scissors) in a upper cabinet shelve. All cleaning compounds/detergents are stored so that they are inaccessible to children.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 01/17/2020
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LPA reviewed children records, records were complete. All required licensing document were posted and observe to be located in the hallway near the playroom. All electrical outlets were properly covered. The home is clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and carbon monoxide that is in operational condition.

This facility has a fire extinguisher 2A10BC meets fire marshal standards and was operational during visit. The home has a working telephone service available. Per licensee, disaster/fire drills are conducted every six months. LPA observed disaster/fire drill log as current.



This home was orderly and comfortable for children in care. LPA observed that licensee and her assistant have a valid Pediatric CPR and First Aid card. The licensee's Pediatric CPR card is valid until 08/2020 and the licensee's assistant Pediatric CPR is valid until 09/2021. Copy obtained for file. This facility has a current roster. Licensee has completed mandated reporter training and has the required immunization for pertussis and measles, licensee declines the influenza shot.

Areas off limit include: all bedrooms and bathroom upstairs, garage, laundry room. A security gate was observed on the staircase that leads to the upstairs bedrooms.

Per licensee there are no weapons or firearms on the premise.



SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 01/17/2020
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Child have access to the backyard area. There is a grassy area for active play. The backyard is completely surrounded by brick fencing. LPA observed several toys in the back yard area in which children have access to. The toys observed, were in good condition and free of cracks. There is a large wooden playing apparatus on the yard. The play apparatus has a climber, swing, and slide. The play apparatus was inspected and it was secured and anchored to the ground. There is grass underneath the play apparatus; enough cushion to aid a child if he/she were to fall. There were several high chairs that were observed to be on the backyard.

There is a pool on the premises of this facility. The pool was inspected, it is surrounded by wrought iron fencing is at least five feet high. The fence is constructed so that it does not obscure the pool from view. The wrought iron gate swings away from the pool. The pool has a self-closing latch located no more than four inches from the top of the gate. The gate was able to close by itself with assistance. Pool can be observed through the glass window in the kitchen.
Licensee is not providing any medical services to children. 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

The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the home. Individuals within one month of their 18th birthday must be fingerprinted immediately or at least within 30 days or less of turning 18
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 01/17/2020
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There shall be no smoking, no infant walkers, johnny jumpers, exersaucers and any other item that falls into that category. Also discussed were earthquake, fire & disaster drills shall be documented at least once every six months. Posting requirements were discussed such as the posting of the Parent’s Rights poster in a visible location for the children’s authorized representatives. Children records requirements, mandated child abuse and injury/ death reporting, background check clearance transfer requirements, SIDS, Infants Safe Sleep on Back, and Never Shake A Baby were all discussed. Licensee agrees children shall be positioned for sleep on their back.

**Licensee informed to review updates/regulations for 2016/2017 on the department website: www.ccld.ca.gov ; AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles, and TB clearance, beginning September 1, 2016; AB 2231 Effective July 1, 2017 - Civil Penalty Amount changes. At the time of this inspection LPA set up licensee to received Quarterly PINS and licensing updates. Licensee was provided with an updated family child care home Notification of Parents Rights.

This facility was in compliance with Title 22 Regulations. No citations were issued during this inspection. A copy of this report was read and discussed with licensee. Notice of Site Visit was left at the facility.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
LIC809 (FAS) - (06/04)
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