197417279-11-10-2022-12-CC-AALH-CL2T2F-20221110132040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417279
Report Date: 11/10/2022
Date Signed: 11/10/2022 01:21:27 PM

Document Has Been Signed on 11/10/2022 01:21 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:	ABBOTT FAMILY CHILD CARE		FACILITY NUMBER:	197417279
ADMINISTRATOR:	ABBOTT, GUM JIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 255-8783
CITY:	STEVENSON RANCH	STATE: CA	ZIP CODE:	91381
CAPACITY:	14	CENSUS: 6	DATE:	11/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Licensee Abbott Gum Jin		TIME COMPLETED:	01:50 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 11/10/22 Licensing Program Analysts (LPA) Andrew Alemoh met with Licensee Abbott Gum Jin, and assistant #1 who guided analyst on a tour of the facility for the One Year Required Inspection. This is a one story 4-bedroom, 3-bathroom home with kitchen, dining room area, family room, and playroom and detached garage. Upon arrival LPA observed 6 children with the licensee and Assistant #1. Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the left. Children have access to the family room, and living room, children's bathroom, and backyard. Off limit area includes 4 of the home’s bedrooms, 1-bathroom, front yard, kitchen, laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under the sink and children bathroom, and laundry room), medicines (locked in off limits master bedroom) and hazardous items (sharp knives are inaccessible by being on top kitchen cabinet far from children reach) that can pose a danger to children. The home has a fireplace but is screen and covered with a chair. The home has safe and age-appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (3A40BC) are in operable condition. Per Licensee no one smokes in the home. No baby bouncer’s saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the living room. Per Licensee there are no weapon/firearms in the home. LPA's advised licensee that all electrical outlets must be inaccessible. The last documented fire/earthquake drill was completed 10/26/22, LPA's advised licensee to conduct and document disaster drills every six months. Roster complete and maintained current.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

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: ABBOTT FAMILY CHILD CARE	FACILITY NUMBER: 197417279
	VISIT DATE: 11/10/2022

NARRATIVE

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Bathroom: Shower/tub are free of hazards (childcare bathroom). Toilet and faucet are clean and operable.

Kitchen: Sharp utensils are inaccessible. Per licensee AM snack, lunch, and PM snack are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked under the bathroom sink and kept in child locked laundry room. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard and front yard is completely fenced and safe for children. Per licensee children do not use the homes front yard. The outdoor area has concrete areas for children to play. LPAs observed the toys in the backyard to be in safe condition. LPA noticed there is a pool in the backyard that is fenced all around.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 07/28/23. Mandated Reporter was completed 01/14/22 and expires 1/14/24. Children nap on mats in the living room. LPAs observed 0 dogs on the premises.

Documents discussed: Title 22 Personal Records 102416.1, Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

Licensee 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

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: ABBOTT FAMILY CHILD CARE	FACILITY NUMBER: 197417279
	VISIT DATE: 11/10/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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. LPA 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 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

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC809 (FAS) - (06/04)

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