197493203-8-3-2021-12-CC-LTMR-C5JND2-20210803102137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493203
Report Date: 08/03/2021
Date Signed: 08/03/2021 10:21:42 AM

COMPREHENSIVE INSPECTION

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:	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: 0	DATE:	08/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ana Peralta Garcia		TIME COMPLETED:	10:37 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) Thompson-Miller met with Licensee Ana Peralta Garcia who guided analyst on a tour of the facility for an One Year Required Inspection. This is a single story 3 bedroom, 2 bathroom home with kitchen/dining, living room, laundry room, enclosed patio and garage. The garage is used for storage only and no child care activities are conducted there. There is no body of water. Family members residing in the home include 2 adults (Licensee, Licensee Spouse) and two children. Days/Hours of operation Monday through Friday, 6:00AM to 7:00PM. During the inspection Licensee provided an updated facility sketch (house). Incidental Medical Services (IMS) were discussed. Physical Plant: Main care is provided in the enclosed patio. Children use the bathroom in hallway on the right. Children have access to the backyard. Off limit areas include all Bedrooms, bathroom #2, laundry room (left side at entrance) and the garage. 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 (off limits bedroom), and hazardous items (sharp knives in upper cabinet in kitchen, tight fitting container) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. The home is clean and orderly. FIreplace is screened. There is a designated area for ill children as necessary in the living room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. There are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell). Children nap on mats and playpen. There is one large dog (off limits room).

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PERALTA GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 197493203
	VISIT DATE: 08/03/2021

NARRATIVE

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Kitchen/bathroom: Bathtub and shower are free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean and operable, home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located in off limits garage. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch and snacks will be provided.

Outdoor: The backyard (grass) is completely fenced with a patio. Little Tikes play equipment which is age appropriate and shaded patio. The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid 10/23/2022. Electrical outlet are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. Window cords throughout the home are inaccessible. There is cushioning or resilient material around the play structures.

Documents Provided and or Discussed: The following were observed to be in regulation of Title 22 requirements: Fire Drill Log is current, Roster is up to date, Postings were observed and meet Title 22 requirements, Safe Sleep and Lead Poisoning flyer's observed Staffing and Ratio in regulation. Licensee stated currently does not have child care insurance.

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

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

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PERALTA GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 197493203
	VISIT DATE: 08/03/2021

NARRATIVE

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The following was discussed with the Licensee:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed; Licensee were reminded that 100% supervision is required at all times to children in care; Licensee were made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing 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 any kind during the operation of the day care.

Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

No deficiencies. The On Duty Worker is available Monday through Friday 8AM to 5PM. Exit interview conducted and a copy of this report was read and provided to Licensee Ana Peralta Garcia on this date.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC809 (FAS) - (06/04)

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