197417978-3-28-2023-12-CC-JDMO-CQCV7E-20230328161102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417978
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:11:26 PM

Document Has Been Signed on 03/28/2023 04:11 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:	CUNNINGHAM FAMILY CHILD CARE		FACILITY NUMBER:	197417978
ADMINISTRATOR:	CUNNINGHAM, EULA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 206-9048
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 1	DATE:	03/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Eula Cunningham		TIME COMPLETED:	04:20 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 03/28/2023, at 12:55 p.m., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at the Cunningham Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements. LPA Del Mundo met with Licensee, Eula Cunningham and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: extra room in the front of the facility, den, hallway bathroom #1 and outdoor play area. Licensee states the day care hours of operation is 24 hours, 7 days a week. Currently living in the home is licensee and licensee's adult son. Licensee is providing transportation (pick up time: 7:30 a.m. and 3:00 p.m.; drop of time: 3:30 pm) to children in care. Physical Plant The facility is a one story house. The home is clean and orderly with heating and ventilation for safety and comfort. Licensee 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 such as breakfast, lunch, 2 snacks for children in care. 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.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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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Document Has Been Signed on 03/28/2023 04:11 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: CUNNINGHAM FAMILY CHILD CARE	FACILITY NUMBER: 197417978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having a current mandated reporter training which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee will email a copy of the Mandated Reporter training certificate of licensee to LPA.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee do not have any measles and pertussis vaccination records on file and 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: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee will email copies of immunization records of measles and pertussis to LPA.

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/28/2023 04:11 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: CUNNINGHAM FAMILY CHILD CARE	FACILITY NUMBER: 197417978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)

Admission Procedures and Parental and Authorized Representative's Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee dis not maintain records of LIC 995A Notification of Parents' Rights for child #1, #2, #3, #4 and #5 and 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: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee will email copies of signed parents' LIC 995A Notification of Parents' Rights for child #1, #2, #3, #4 and #5 to LPA.

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
1 2 3 4	Based on record review, the licensee dis not maintain records of LIC 700 Identification and Emergency Information for child #4 and #5 and 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: 04/14/2023
	Plan of Correction
1 2 3 4

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/28/2023 04:11 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: CUNNINGHAM FAMILY CHILD CARE	FACILITY NUMBER: 197417978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee dis not maintain records of LIC 627 Consent for Emergency Medical Treatment for child #4 and #5 and 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: 04/14/2023
	Plan of Correction
1 2 3 4	Based on record review, the licensee dis not maintain records of LIC 627 Consent for Emergency Medical Treatment for child #4 and #5 and did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee dis not maintain records of LIC 282 Affidavit Regarding Liability Insurance for child #4 and #5 and 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: 04/14/2023
	Plan of Correction
1 2 3 4

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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: CUNNINGHAM FAMILY CHILD CARE	FACILITY NUMBER: 197417978
	VISIT DATE: 03/28/2023

NARRATIVE

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The home is free from defects or conditions which might endanger a child. The fireplace is located in the den and is covered with a metal and glass screened to prevent access by children. It has operational carbon monoxide-smoke detector and fire extinguisher which meet established standards. Poisons, detergents, cleaning compounds are stored in the kitchen (off limits) where they are locked and inaccessible to children. Licensee is advised to put safety knobs on the stove. Medicines are stored in the upper cabinet of the back bathroom (off limits) and are inaccessible to children. First aid kit box is in storage closet in the hallway. Per licensee, there are no firearms in the facility. Licensee is advised that all children, age and ability permitting, and the provider, the assistant provider (if any), 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 (date 03/28/2023, 10:00 a.m.) once every six months, 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 seven children with no infants enrolled in their program. 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 no body of water on the premises. The rear yard gate is scheduled to be repaired and clean on March 30, 2023. 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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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: CUNNINGHAM FAMILY CHILD CARE	FACILITY NUMBER: 197417978
	VISIT DATE: 03/28/2023

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 do 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 from other children in the den area.

Facility Administration
The licensee has no current mandated reporter training certificate. The licensee is advised to complete the online mandated reporter training at www.mandatedreporterca.com The Licensee has current Pediatric CPR and First Aid training certificate which expires on 09/24/2021. Licensee has no proof of immunizations against influenza, pertussis and measles. Licensee has TB skin test on file. Licensee is 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 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). Any changes to the facility from an area of the family child care home should be reported to the Department.
The Licensee and other persons associated to the facility have obtained appropriate clearance or a criminal record exemption as required by the Department.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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: CUNNINGHAM FAMILY CHILD CARE	FACILITY NUMBER: 197417978
	VISIT DATE: 03/28/2023

NARRATIVE

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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. At the time of inspection, four documents (LIC 282, LIC 700, LIC 627and LIC 995A) are not maintained for the five children enrolled in the day care.

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

The Facility is not in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo observed deficiencies that may hinder the health and safety of the children in care. Deficiencies were cited during inspection. An exit Interview and discussion of observations were conducted with the licensee.
A copy of this Report was reviewed, Notice of Site Visit (LIC 9213) and Appeal Rights were provided to Licensee, Eula Cunningham.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC809 (FAS) - (06/04)

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