197417279-11-15-2023-12-CC-AALH-CXLTWY-20231115140618

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417279
Report Date: 11/15/2023
Date Signed: 11/15/2023 02:06:26 PM

Document Has Been Signed on 11/15/2023 02:06 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:	11/15/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Licensee Gum Jin Abbott		TIME COMPLETED:	03:00 PM

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On 11/15/2023 Licensing Program Analyst (LPA) Andrew Alemoh, met with licensee, Gum Jin who guided analyst on a tour of the facility for the One Year Required inspection. This is a two-story home with a safety gate barricading the stairwell. Upon arrival LPA observed 6 children in care with the licensee and an aid providing caring and supervision. Family members residing in the home include 2 adults (licensee, licensee adult son). Facility hours of operation are Monday - Friday 8AM- 5:30PM. Incidental Medical Services (IMS) policy was discussed.

There are bodies of water on the premises.

Physical Plant: Main care is provided in the playroom area. Their are cubbies for children to place their belongings. Age appropriate toys and play equipment were observed in the playroom as well as cots. The children use the bathroom located in the hallway to the left. The off-limits areas are all upstairs three bedrooms, second restroom, office area and the kitchen. Laundry room and garage are also off limits and are kept locked during business hours. 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 which are kept in the garage and laundry room inside the cubby, medicines/vitamins are kept in licensee's bedroom and hazardous items (sharp knives are kept in the off-limits kitchen area high enough and around/near the refrigerator which is inaccessible to children.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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: ABBOTT FAMILY CHILD CARE	FACILITY NUMBER: 197417279
	VISIT DATE: 11/15/2023

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Safe and age appropriate toys, play equipment and materials were observed.

The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No 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. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on October 16th 2023. A fireplace was observed on the premises to be screen and made inaccessible to children.

Bathroom: LPA observed the toilet and faucet are clean and operable. Underneath the bathroom their are safety latches which contain extra toiletries.

Kitchen: Off-limits barricaded by a safety gate. Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the laundry room, and garage area which is locked during business hours. Snack, lunch, snack and are provided. Licensee stated she currently does not have a food program. Naps are provided on cots the play room area.

Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall. There are one dog in the premises. Per licensee, dogs do not come in contact when children are present. LPA observed age appropriate toys, well secured and safe for children. There is no BBQ pit on the premises.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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: ABBOTT FAMILY CHILD CARE	FACILITY NUMBER: 197417279
	VISIT DATE: 11/15/2023

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There is a swimming pool and a spa in the backyard. The bodies of water are completely enclosed by a 5 ft iron fence. The fence runs all the way down to the concrete on which it sits, leaving no room between the bottom of the fence and the concrete. The pool gate was tested and observed to be self-closing and self-latching. The gate has an installed mechanism containing a key to lock the gate and it is located within 6 inches from the top of the gate. The lever to open the gate is located at the top of the gate. The pool gate opens away from the body of water. All items rendering the fence climbable are moved away from the fence. The iron fencing is sturdy and capable of withstanding the impact of children's toys including bicycles.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 01/25. Mandated Reporter expires on 01/06/25. LPA reminded licensee; mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have child care insurance.

Licensee Jin 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: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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: ABBOTT FAMILY CHILD CARE	FACILITY NUMBER: 197417279
	VISIT DATE: 11/15/2023

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LPA discussed the safe sleep regulations with licensee Jin and discussed the Child Care Licensing Safe Sleep web page 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.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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