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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415695
Report Date: 08/10/2023
Date Signed: 08/10/2023 02:16:20 PM


Document Has Been Signed on 08/10/2023 02:16 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:ROSALES FAMILY CHILD CAREFACILITY NUMBER:
197415695
ADMINISTRATOR:ROSALES, NORMA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 365-1582
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY:14CENSUS: 3DATE:
08/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Norma Rosales,LicenseeTIME COMPLETED:
02:30 PM
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On 08/10/23 Licensing Program Analysts(LPAs) Justeene Tamayo and Evelyn Garcia met with Licensee, Norma Rosales, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 3 bedroom, 1 bathroom home with kitchen/dining, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 2 infants and 1 preschool child in care. There is only the licensee living in the home. Facility operation are Monday-Friday 8AM-5:30 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the left. Children have access to the living room and room #1. 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 (in upper kitchen cabinet), medicines (upper kitchen cabinet ) and hazardous items (sharp knives in upper kitchen pantry unreachable to children in care) that can pose a danger to children. LPAs observed the fireplace to be screened. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, LPAs reminded licensee no baby bounces or any recalled and or prohibited toys or sleep/ play equipment are allowed on the premises. There is a designated area for ill children as necessary in the living room by the door entrance. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ROSALES FAMILY CHILD CARE
FACILITY NUMBER: 197415695
VISIT DATE: 08/10/2023
NARRATIVE
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Fire/Disaster Drills are complete and maintained current. Last Fire/Disaster drill was completed on 08/10/23.

During file review, licensee was unable to locate LIC700 Emergency Information and current immunization's for children #1-3. Facility has been cited been two Type B Citations. Please see LI809-D for deficiency page.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. Toilet and faucet are 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. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the upper kitchen cabinet inaccessible to children in care. Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in the living room.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with wooden fence). There is no body of water. LPAs observed age appropriate toys. Per licensee, there are no pets on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 05/17/2024. Mandated reporter training is complete and maintained current. Mandated Reporter Training expires 08/21/2024.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ROSALES FAMILY CHILD CARE
FACILITY NUMBER: 197415695
VISIT DATE: 08/10/2023
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Documents Provided and or Discussed: Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan LIC9227, and Emergency Disaster Plan. Licensee stated currently does not have child care insurance.

Licensee Rosales 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.

LPAs discussed the safe sleep regulations with licensee Rosales 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. LPAs also informed licensee 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 to licensee 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 Norma Rosales, along with her appeal rights and Notice of Site Visit.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/10/2023 02:16 PM - It Cannot Be Edited

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: ROSALES FAMILY CHILD CARE
FACILITY NUMBER: 197415695

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee was unable to find current immunizations for children #1-3, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Licensee shall document and keep immuization records for each child enrolled. Licensee will send a copy of children #1-3 immunzations to LPA Tamayo no later than 08/31/23.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee was unable to find current emergency information LIC700 for each child enrolled, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Licensee shall ensure she has copies of LIC700 for each child enrolled. Licensee will send copies of LIC700 to LPA Tamayo no later than 08/31/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4