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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419812
Report Date: 02/07/2024
Date Signed: 02/07/2024 02:19:23 PM

Document Has Been Signed on 02/07/2024 02:19 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
197419812
ADMINISTRATOR:RODRIGUEZ, RHONDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
8186170252
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Rhonda RodriguezTIME COMPLETED:
02:45 PM
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On Wednesday, February 7, 2024, at 9:45 a.m., Licensing Program Analyst (LPA) Evelyn Garcia conducted an unannounced annual inspection and met with licensee Rhonda Rodriquez who guided LPA Garcia on a tour of the facility.

Family members residing in the home have been discussed with licensee and one uncleared adult was observed by LPA Garcia. Operating hours are Monday to Friday from 6:00 a.m. to 6:00 p.m., Saturday 7:00am – 2:00pm and care for children ages 0 to 13 years old.

This facility is a single-story home that consists of 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, office, bonus room (daycare), garage and front and backyard fenced.

Areas off limits to children include- 3 bedrooms, 1 bathrooms (in bedroom), kitchen, and front yard. Areas accessible to children include the bonus room (daycare), living room, dining room, backyard and bathroom located in the hallway on the left near the entrance of the home.

LPA Garcia inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and landline). For ventilation, LPA Garcia observed central AC and the vents located on the high walls of the home. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA observed a fireplace located in daycare room, however there is a shelf placed with toys directly under the fireplace that makes it inaccessible to the children in care and a large activities calendar is placed over the entirety of the fireplace, covering it completely. LPA observed 2 pack and plays that are used for infant in care.

LPA Garcia observed cleaning compounds items stored in the kitchen in a cabinet under the sink that is locked with safety lock.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 02/07/2024 02:19 PM - It Cannot Be Edited


Created By: Evelyn Garcia On 02/07/2024 at 01:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 count which poses an immediate health, safety or personal rights risk to persons in care. The uncleared adult #1 was observed to be in the home which poses an immediate Health, Safety or Personal Rights risk to children in care.
POC Due Date: 02/08/2024
Plan of Correction
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Uncleared adult #1 will not be in the presence of the children until their fingerprints have been cleared on Guardian.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2024


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Document Has Been Signed on 02/07/2024 02:19 PM - It Cannot Be Edited


Created By: Evelyn Garcia On 02/07/2024 at 01:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee stated that documentation was not kept for Child#1.
POC Due Date: 02/21/2024
Plan of Correction
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The licensee will have log out and easily accessible so she can document while infants nap.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2024


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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812
VISIT DATE: 02/07/2024
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 Knives and sharp objects were observed to be stored in kitchen drawer that is made inaccessible by safety gate. Medications and supplements are stored in high kitchen cabinet also made inaccessible by safety gate as kitchen is off-limits. For water drinking, licensee stated she provides water bottles. The licensee stated that she participated in a food program, the facility provides breakfast, lunch, snacks, and dinner as needed. LPA informed licensee any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. Licensee stated she currently does not have any children with severe food allergies nor on medication.

LPA Garcia entered the bathroom and observed the toilet, hand washing sink, hand soap and LPA observed the bottom sink cabinet closed and did not observe hazard materials and observed the restroom to be in good condition. LPA observed personal hygiene items in shower and licensee promptly removed them and made them inaccessible. LPA reminded licensee such materials must remain inaccessible to children during operating hours.

LPA Garcia asked the licensee if there were any pets, poisons, firearms, weapons, or bodies of water. The licensee stated she has 2 dogs, no poisons and no bodies of water, no firearms, and no weapons. LPA did not observe firearms, weapons, nor bodies of water. However, dogs were heard briefly barking from bedroom. The license was informed that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



LPA Garcia observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged. LPA observed carbon monoxide detector and smoke alarm located in the daycare room and living room. Licensee tested the carbon monoxide and smoke alarm. LPA Garcia heard the sounds and are operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the hallway. For ill isolation, licensee stated she utilizes the living room away from other children. Last drill conducted 2/7/2024.

LPA Garcia inspected the play outdoor (backyard) area that is utilized by children for safety, comfort, and cleanliness. LPA observed the backyard to be fenced and gates closed and with a keypad lock. LPA observed the play equipment to be age appropriate and in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards (grass, concrete, rubber mats). Climbing structures were placed over grassy area and rubber matting to minimize injuries from falls. For outdoor water drinking, children bring out bottled water.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812
VISIT DATE: 02/07/2024
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LPA Garcia observed licensee Pediatric First Aid/ CPR certification dated 7/23/22 and Health and Safety certification dated 5/25/2008, and licensee has proof of immunization against Pertussis and Influenza declination. However, does not have proof of MMR. Licensee stated she received it when living out of state as a child and does not have a record of it. LPA informed licensee she can go to a clinic to verify she has had the vaccination. Licensee has completed the Child Abuse Mandated Reporter (AB 1207) training dated 12/8/23. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA observed the required postings License, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch. LPA also, reviewed children roster, children files and staff files.


The following was also discussed with the licensee:

1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.



7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812
VISIT DATE: 02/07/2024
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8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.



10. Children and staff records must be maintained and updated as needed and be available for review by the Department.

11. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.



13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

13. Dog(s) and/or pets are recommended to be isolated from children in care.

14. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812
VISIT DATE: 02/07/2024
NARRATIVE
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 Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. One type A deficiency is being issued today for regulation 102370(d)(1) regarding the uncleared adult observed in the home. Please see attached LIC 809-D for citation. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197419812
VISIT DATE: 02/07/2024
NARRATIVE
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The deficiency listed on the following page was observed by LPA Garcia and is being cited in accordance with California Code of Regulations Title 22. One type B deficiency is being issued today for regulation 102425(j)(2) – The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following…. Please see attached LIC 809-D for citation.

Other deficiencies recorded included: 2 Type V Violations for no documentation for MMR vaccine, and CPR certification not being EMSA Approved. Licensee will submit the following documents to LPA by 2/22/24.


A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Rhonda Rodriquez.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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