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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415632
Report Date: 08/03/2021
Date Signed: 08/03/2021 03:43:43 PM

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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
197415632
ADMINISTRATOR:DIAZ, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 233-2441
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 6DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Pamela DiazTIME COMPLETED:
03:35 PM
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On 8/3/2021, Licensing Program Analyst (LPA) Carol Heath met with the licensee, Diaz Pamela who granted access into the home. The purpose of the inspection is to conduct an unannounced Required 1 Year inspection at the above facility. Licensee is licensed to provide care and supervision for a Large family child care for the capacity of 14 children. During the time of this inspection licensee had 6 children in care. Children were observed to be actively playing in the playroom. There were 2 children under the age of 2 years old, 3 children between the ages of 4 to 5 years and 1 school age observed to be on the premises.

Currently residing in the home is the licensee, her spouse and her daughter (17 years old). LPA toured the home inside and out Per LIS, facility annual fees are current. This facility operates from less than 24 hours Monday- Sunday. Incidental Medical Services (IMS) policy was discussed.
The home is set up as follows:

This is a two story house with 4 bedrooms, 3 bathrooms, 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 Dining room/ Living room, Room #1 (den/office room, near the main door entrance), and room #2 (downstairs bedroom), child also have access to the kitchen area.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 08/03/2021
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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. 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 in the garage, so that they are inaccessible to children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 08/03/2021
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Backyard: The backyard is fenced. 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 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 was a high chair that were observed to be on the backyard. AC/Heating unit is behind a gate area which made it inaccessiable to the children.

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.

There is a fireplace located in the living room which is properly screened and meets all safety requirements. The home has central AC and heat. Per licensee, there are no weapons or firearms on the premises. LPA observed there is a required fire extinguisher on (2A10BC). The Fire extinguisher is located outside the Room 1. The smoke detectors and carbon monoxide devices tested operable. The First Aid Kit was observed complete with supplies and a first aid manual in the bathroom under the sink.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 08/03/2021
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The Licensee is providing Incidental Medical Services. LPA and the Licensee discussed the requirement and asked her to submit IMS plan by 8/4/2021 @ 5:00 PM. 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

· LPA observe licensee has current Pediatric CPR and First Aid Training with expiration date (July/2022) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.


· The licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.
· The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 7/6/2022
· Licensee does not provide transportation for children.
· LPA reviewed 6 children's and 1 assistant records, the records are complete.
· Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on Last month.
· LPA observed the Facility Roster. Per Licensing Information System, facility annual fees were current.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 08/03/2021
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· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is not current. there are no current facility earthquake/fire drills documents observed during the time of this inspection.

The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü Licensee was 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 and on the form LIC624B
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 08/03/2021
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ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507
ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare 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.
ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.
ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.
ü LPA provided consultation during the inspection.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197415632
VISIT DATE: 08/03/2021
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No deficiencies are being cited at this time, the facility complies with Title 22

Exit interview conducted with Licensee. A copy of this report is discussed and left with the licensee.
.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7