197418002-1-6-2020-12-CC-JNEL-BKKRNR-20200106121047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418002
Report Date: 01/06/2020
Date Signed: 01/06/2020 12:10:56 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:	VILLALOBOS FAMILY CHILD CARE		FACILITY NUMBER:	197418002
ADMINISTRATOR:	VILLALOBOS, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 533-3304
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	14	CENSUS: 4	DATE:	01/06/2020
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Anna Villalobos		TIME COMPLETED:	12:30 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	Licensing Program Analyst (LPA) Neal met with Licensee, Ana Villalobos, who guided analyst on a tour of the facility for the purpose of a Required 3- Year random inspection. This is a single story 4 bedroom, 3 bathroom home with kitchen, dining room, living room, family room, laundry room and garage. The garage is used for storage only and no child care activities are conducted there. There is a jacuzzi and an in ground pool on the premises. Family members residing in the home include 3 adults (licensee, licensee spouse, licensee's mother) and 1 child. Assistant was present during inspection and 4 child care children. Incidental Medical Services (IMS) policy was discussed. Main care is provided in the living room and family room. Children use the bathroom in the hallway next to the laundry room (child safety knob). Off limit areas include the home all the bedrooms (safety knobs observed), other 2 bathrooms, laundry room (safety knob), the right side of the backyard (gated pool area) and the garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (child locked kitchen cabinet), medicines (upper kitchen cabinet) and hazardous items that can pose a danger to children. Sharp knives are stored on top of refrigerator. Roster complete and maintained current. Fire/earthquake drills are also current. A sample of children and staff files were reviewed. Required documents are posted. Children play in the backyard on the left gated side. There is a grass and concrete area for active play with small play structures. There is a barbecue island is covered.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197418002
	VISIT DATE: 01/06/2020

NARRATIVE

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The propane section is at the bottom of the island (inaccessible). The backyard is completely fenced. Licensee has one small dog. LPA observed the pool gate to the in-ground pool and jacuzzi to be gated with proper self-closing and self-latching that meets regulations. The gate is padlocked. Licensee was advised to ensure herself and anyone who assists at the child care has access to the key at all times as well.
Per Licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There are age appropriate toys and napping equipment on the premises. Children nap on cots in the main care area. The required smoke detector, carbon monoxide detector and Fire Extinguisher are in operable condition. Fireplace is screened. Home has central AC and heat. CPR/First Aid expires 10/18/2021 for licensee and assistant present during inspection. The First Aid kit was observed. Mandated Reporter training has been completed (8/30/2019). Licensee was reminded Mandated Reporter training for Child Care must be completed every 2 years for licensees and any adult assisting at the day care.
The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family child care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197418002
	VISIT DATE: 01/06/2020

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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12 month period, PER PERSON.

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

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. Handout on Safe Sleep Concepts was given and discussed.

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 serious 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 in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

No deficiencies were cited during this inspection.
Exit interview was conducted, report was read and a copy was provided to the Licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

LIC809 (FAS) - (06/04)

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