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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416130
Report Date: 10/16/2019
Date Signed: 10/16/2019 05:52:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:FIGUEROA FAMILY CHILD CAREFACILITY NUMBER:
197416130
ADMINISTRATOR:FIGUEROA, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 946-9237
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 5DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Ana Figueroa TIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lady King-Lewis conducted an Annual Random inspection at the above facility. Upon arrival LPA was greeted by licensee, Ana Figueroa. LPA observed 5 children and 0 infants. A copy of Child Care Facility Roster was not received. Licensee states hours of opearation is 5:00 AM to 6:00 PM. LPA provided licensee with a Child Care Facility Roster to complete. Licensee currently caring for all school age children . Children immunization records are not required. Per Licensing Information System (LIS) 1 adult residing in the home have not obtained background clearances. Per LIS, facility annual fees are current and the licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision.

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

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
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 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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: FIGUEROA FAMILY CHILD CARE
FACILITY NUMBER: 197416130
VISIT DATE: 10/16/2019
NARRATIVE
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The home is clean, orderly, comfortable and well ventilated. Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children. LPA observed working smoke detector and Carbon Monoxide, fully charged 2A10BC fire extinguisher and working cellphone. There are several age appropriate toys and a first aid kit on the premises. This is a single store 3 bedroom 2 bathroom home with family room, kitchen and rearyard. The licensee states she rents the master bedroom to her sister and her husband. The day care takes place in the family room, dinning area, hallway bathroom, bedroom 1, bedroom 2, and rear yard. The rearyard is completely fenced in. There are no bodies of water in the FCCH. Per the licensee, there are no firearms on the premises.

Licensee, was not able to provide documented fire and disaster drills being conducted at the least every 6 month.

The licensee has current CPR and first aid that expires, 11-04-19. .

The licensee shall take the mandated reporter training.



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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 2 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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: FIGUEROA FAMILY CHILD CARE
FACILITY NUMBER: 197416130
VISIT DATE: 10/16/2019
NARRATIVE
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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 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).

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

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394).

No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake safety and necessity of drills (every 6 months), required forms for children’s files, facility files, posting requirements, penalty, fingerprint clearance, and the transfer process and penalty. For additional information and forms visit our website at: www.ccld.ca.gov

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: FIGUEROA FAMILY CHILD CARE
FACILITY NUMBER: 197416130
VISIT DATE: 10/16/2019
NARRATIVE
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The following was discussed with the licensee:
LPA encouraged licensee to review the attached web site and follow safe sleep best practices:

• Always place infants on their backs for sleeping

• Use only a tight-fitting sheet on the crib or play yard mattress

• Do not hang any items from the crib or above the crib

• Keep all items, including blankets, out of the crib or play yard

• Pacifiers may be used as long as they do not have items attached to them

• Infants should not be swaddled or have any items covering them while sleeping

• The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold

https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: FIGUEROA FAMILY CHILD CARE
FACILITY NUMBER: 197416130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2019
Section Cited

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidence LPA observed and
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was informed Jesus Martinez and his wife Maria Martinez lives in the license daycare home.
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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) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 5 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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: FIGUEROA FAMILY CHILD CARE
FACILITY NUMBER: 197416130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2019
Section Cited

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Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met by evidence: Licensee did not have a current roster for the children being cared for at the time of the visit.
Type B
10/23/2019
Section Cited

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Operation of a Family Child Care Home: Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement was not met by evidence: LPA did not observed a documented
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fire and disaster drill.
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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) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 7 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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: FIGUEROA FAMILY CHILD CARE
FACILITY NUMBER: 197416130
VISIT DATE: 10/16/2019
NARRATIVE
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The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a Type A violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties per violation will be assessed. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered too.

The following deficiencies cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes.

An exit Interview was conducted with licensee and licensee daughter Maira Figueroa a copy of this Report and a Notice of Site visit was provided to the licensee.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7