197416069-1-26-2023-12-CC-JDMO-CNFVA4-20230126151518

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416069
Report Date: 01/26/2023
Date Signed: 01/26/2023 03:15:32 PM

Document Has Been Signed on 01/26/2023 03:15 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:	COTTAGE FAMILY CHILD CARE		FACILITY NUMBER:	197416069
ADMINISTRATOR:	COTTAGE, YVONNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	6612069049
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 10	DATE:	01/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Yvonne Cottage		TIME COMPLETED:	03:30 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 01/26/2023, at 9:30 a.m., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at the Cottage Family Child Care Home to assess the Facility operation of their program, its current physical plant status and its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. LPA Del Mundo met with Licensee, Yvonne Cottage and stated the reason for the inspection. The LPA provided a copy of the Entrance checklist form, LIC 126. At 10:00 a.m., Licensee guided the analyst on a tour of the day care areas. Areas where care is being provided are converted garage/day care room, hallway bathroom, side and rear yard. Licensee states the day care hours of operation is less that 24 hours a day/7 Saturday to Sunday. Currently living in the home is licensee, licensee’s spouse and daughter (16). Physical Plant The facility is a two story house. The home is clean and orderly, with heating and ventilation for safety and comfort, maintains a telephone service, (Licensee was advised that the cell phone shall be charged and available during day care hours) has safe age appropriate toys, play equipment and materials for children in care to use. At the time of this inspection, there are no fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission. Per Licensee, she provides food for children in care.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/26/2023

NARRATIVE

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The home is free from defects or conditions which might endanger a child. The fireplace is covered with a plyboard to prevent access by children. It has operational carbon monoxide-smoke detector and fire extinguisher which meet established standards. Licensee is aware that when children in care are less that five years old, stairs shall be fenced or barricaded. Poisons, detergents, cleaning compounds are stored in the upper cabinets in hallway bathroom where they are locked and inaccessible to children. Medicines are stored in the first aid kit box mounted on a wall in the living room (off-limits). Per licensee, there are no firearms in the facility. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted at least once every six months and/or more often, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility. Licensee is aware that smoking is prohibited on the premises of a family child care home.

Currently, there are two infants in their program and they have play yards. However, Licensee does not maintain an individual sleeping plan for infants. On the other hand, Licensee is aware that there must be one crib or play yard for each infant who is unable to climb out of the crib or play yard. The crib(s) or play yards use by the facility must meet the United States Consumer Product Safety Commission safety standards. Placement of crib(s or play yards shall not hinder entrance or exit to and from the space where infants sleep. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. The mattresses shall be made specifically for the size crib or play yard in which they are placed.

The facility has an above ground pool on the home premises. The outdoor play areas are properly fenced and supervised by the licensee. The LPA explained to Licensee how to obtain information from the Community Care Licensing (CCL) website (www.cdss.ca.gov).

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/26/2023

NARRATIVE

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Care and Supervision
Per Licensee, she is present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences does not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she is separated isolated other children, and the nature of the illness is determined. If it is a communicable disease he/she shall be separated from other children until the infectious stage is over.
Facility Administration
The licensee and assistants has completed or renewed their mandated reporter training and is current. The Licensee does not have any current Pediatric CPR and First Aid training certificate. However, Licensee and assistants has proof of immunizations against influenza, pertussis, and measles. Assistant #1 do not have any TB skin test on file. Also, the licensee did not provide certificate on preventive health practices training. Licensee and assistants were advised to take the training on preventive health practices. At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or within 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

Licensee is aware that personnel records should be maintained on Licensee and each assistant (if any) and contain the following information: Licensee and staff full name; A signed and dated copy of the Notice of Employee Rights [LIC 9052]; Driver's license number if the employee is to transport children; Date of employment; Date of birth; Current home address and phone number; Documentation of completion of training on preventative health practices as required by Section 102416(c). All personnel records are maintained at the facility. Any changes to the facility from an area of the family child care home should be reported to the Department.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/26/2023

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Records
Licensee and other adults living in the home, working at and associated to the facility have received criminal record clearance. There is an emergency information card maintained for each child in care, completed and up to date.

Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

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

Tthe Facility is not in compliance per Title 22 regulations with regard to immunization records and individual sleeping plan documents. During today's inspection the LPA observed deficiencies that may hinder the health and safety of the children in care. Deficiencies were cited during inspection. An exit Interview was conducted and a discussion of observations and this report was conducted. View points were discussed.
A copy of this Report, Review of Staff Records form (LIC 859), Child Care Staff Interview, Notice of Site Visit (LIC 9213), Appeal Rights were provided to Licensee, Yvonne Cottage.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/26/2023 03:15 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2023

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
1 2 3 4	Based on record reiview child #1, 2 and 3 has no immunization records, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Licensee will send the immunization records thru email

Type B

Section Cited

CCR

102425(c)(2)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, the licensee do not maintain an individual sleeping plan for each infant enrolled, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/27/2023
	Plan of Correction
1 2 3 4	Licensee will be sending the documents thru email

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: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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