<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418002
Report Date: 03/02/2022
Date Signed: 03/02/2022 11:48:01 AM


Document Has Been Signed on 03/02/2022 11:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:VILLALOBOS FAMILY CHILD CAREFACILITY NUMBER:
197418002
ADMINISTRATOR:VILLALOBOS, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 533-3304
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 3DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ana VillalobosTIME COMPLETED:
12:02 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 Analysts (LPA's) Justin Dorsey and Justeene Tamayo met with Licensee, Ana Villalobos, 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 area, family room, formal dining room, laundry and garage. There is a pool on the premises. Upon arrival LPA's observed 3 children.

Physical Plant: Main care is provided in formal dining room (converted day care), family room, and dining area. Children use the bathroom in hallway near the laundry room. Children have access to the dining room, formal dining room, family room and the backyard. Off limit areas include all of the homes bedrooms, 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 laundry room), medicines (inaccessible in top kitchen cabinet) and hazardous items (knives located on top of the refrigerator) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers 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 family room. Per Licensee there are no weapon/firearms in the home. LPA's observed one small dog in the home. Per licensee that is the only pet in the home.

Per licensee last fire/earthquake drill was completed 02/22, LPA's observed the last documented drill was 06/21. LPA's advised licensee that she must document the date and time of all disaster drills. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: VILLALOBOS FAMILY CHILD CARE
FACILITY NUMBER: 197418002
VISIT DATE: 03/02/2022
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
26
27
28
29
30
31
32
Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner 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 sink. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children The backyard is completely fenced. The home was licensed with a fenced in ground pool. The backyard has turf and concrete areas for children to play. LPA's observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 12/23, Mandated Reporter for licensee and assistant #1 expired 08/21. LPA's advised licensee to retake the training. Child nap on mats in the main care area (formal dining room).

Documents discussed: Safe Sleep PIN 20-24-CCP, Forms to be Kept in a Child Care Home (LIC 311D) and Large Family Child Care ratios.

Licensee Villalobos 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.

LPA discussed the safe sleep regulations with licensee Villalobos 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 Villalobos 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 Ana Villalobos.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2