197493203-7-19-2019-12-CC-JNEL-BE8MNX-20190719094615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493203
Report Date: 07/19/2019
Date Signed: 07/19/2019 09:46:23 AM

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:	PERALTA GARCIA FAMILY CHILD CARE		FACILITY NUMBER:	197493203
ADMINISTRATOR:	PERALTA GARCIA, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 547-4954
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY:	14	CENSUS: 5	DATE:	07/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ana Peralta Garcia		TIME COMPLETED:	10:00 AM

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 Peralta Garcia, for the purpose of a Random inspection. This is a single story 3 bedroom, 2 bathroom home with kitchen, dining area, living room, laundry area, and garage. The garage is used for storage only and no child care activities are conducted there. There are no bodies of water on the premises. Family members residing in the home include 2 adults (applicant, spouse) and two children. There were 5 child care children present during this inspection. Incidental Medical Services (IMS) were discussed. Main care is provided in Bedroom #1 (on the left of the entrance). Children use the bathroom down the hall to the right. Children have access to the backyard. Off limit areas include Bedrooms #2 and #3 (safety latches observed), master bathroom, kitchen, and the garage. LPA observed safety latches on the washer/dryer. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents (garage), cleaning compounds (garage), medicines, and hazardous items that can pose a danger to children. Sharp knives are kept in an upper kitchen cabinet in a container. Kitchen has safety gates on both sides for inaccessibility. Door located inside the children's restroom is child locked. Facility roster was observed to be maintained current. A sample of children's files were reviewed. Licensee has an emergency kit stored in closet across from bedroom #1. LPA observed age appropriate toys and equipment. There are mats and pack and plays are available for napping children. Children play in the backyard. Licensee has one large dog. There is a gated dog run on the left side of home.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019

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: PERALTA GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 197493203
	VISIT DATE: 07/19/2019

NARRATIVE

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Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. The required smoke detector, carbon monoxide detector and fire extinguisher are in operable condition. Fireplace is screened. Home has central AC and heat. Licensee has a First Aid kit. Licensee and her assistant's (spouse) pediatric CPR/First Aid expires 10/2020 . LPA observed the required postings.
Mandated Reporter training for Child Care was completed 11/11/2018 (licensee) and 11/20/2018 (spouse). Licensee was reminded that the mandated reporter training must be taken every 2 years. Safe sleep handout was given and discussed.

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.

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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019

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: PERALTA GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 197493203
	VISIT DATE: 07/19/2019

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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. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents.

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 Licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019

LIC809 (FAS) - (06/04)

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