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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493203
Report Date: 11/09/2022
Date Signed: 11/09/2022 03:49:58 PM


Document Has Been Signed on 11/09/2022 03:49 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:PERALTA GARCIA FAMILY CHILD CAREFACILITY NUMBER:
197493203
ADMINISTRATOR:PERALTA GARCIA, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 547-4954
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 1DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Ana Peralta GarciaTIME COMPLETED:
04:00 PM
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On 11/9/2022, Licensing Program Analysts (LPASs) Carol Heath and Kuliema Calloway conducted an unannounced Required 1-Year inspection at the Peralta Garcia Family Child Care. Upon arrival, the LPAS met with the licensee, Ana Peralta Garcia who guided the LPAS on a tour of the facility. Family members residing in the home include 2 adults (Licensee, Licensee Spouse) and two children (15 and 13 years old). All adults living in the home have been background cleared. Per the licensee, the hours of operation are Monday through Friday 6:00 a.m. to 7:00 p.m. Licensee's assistants were present during this inspection, and 1 child (16 months) children. Incidental Medical Services (IMS) were discussed.
The Home is set up as follows:
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 childcare activities are conducted there. There is no body of water. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.
Ø Main Area: Main daycare will be provided in the living room (at the entrance) and enclosed patio. Children have access to the kitchen dining area. Children have access to the backyard.
· Living Room/Enclosed patio: In the areas, LPAS observed age-appropriate toys and furniture for the children. LPAS observed: A small table was observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. A small play kitchen was located by the door with which children can play. There are games and books on the premises of this facility.
· Children's Bathroom (#1): Children use the bathroom down the hallway on the right. The Bathroom was toured and inspected sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet and drawers. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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: 11/09/2022
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· Kitchen/Dining Room: The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). In the kitchen, all sharp utensils, poisons, and medications are made inaccessible to children with child safety latches on cabinet doors and drawers. Sharp knives in the upper cabinet in the kitchen, tight fitting. Container. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, and snacks will be provided.
· Backyard: The backyard was inspected; The backyard is gated all around. Children play in the backyard. The backyard (grass) is completely fenced with a patio. Little Tike plays equipment which is the age-appropriate and shaded patio. The play area is clear and clean of debris, the play area is fenced and gated all around, no body of water on the premises. LPAS observed some gardening tools in the backyard. According to the licensee, the children do not go the area. LPASs reminded the licensee to have adult supervision at whole time.
Ø Off-limit: The areas include all Bedrooms, bathroom #2, laundry room (left side at the entrance) and the garage.
Ø Others:
· AC/Heating Unit was observed. AC/Heating Unit is located on the right side of the home and is inaccessible to children via barrels blocking access to the unit.
· Bodies of water: Per the licensee, there are No bodies of water in the home. There is a decorative water fountain that has no water.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Fire extinguisher (2A10BC): LPAS observed there is a required fire extinguisher (2A10BC) fully charged and located in the laundry room inaccessible to children. It meets standards established by the State Fire Marshall.
· Fireplace: The fireplace was observed in the off-limits living room and is screened to make it inaccessible to the children.
· Hanging window blind cords: The cords are inaccessible to children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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: 11/09/2022
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· Incidental Medical Services (IMS): 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.
· Isolation area (Illness): Per the licensee, if the child shows signs of illness, he/she will be separated from other children and stay in Living Room.
· Medications and cleaning solutions: Detergents/cleaning compounds are in the Garage. Medications are in the off-limits bedroom.
· Napping: Children will nap in the designated nap areas with adult supervision. LPAS observed 2 mats and 3 playpen in the closet.
· Overnight Care: Pre-licensee, does not provide overnight care.
· Pets: 1 dog. They have current vaccinations. The dog does not interact with daycare children.
· Phone service: There is a working landline or cell phone
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· The First Aid kit is located in the key-locked closet inaccessible to children. The First Aid Kit was observed complete with supplies and a first aid manual.
· Transportation: The licensee will not transport daycare children.
· Weapons or Firearms: Per Licensee, there are no Firearms at the facility at this time. LPAS does not observe any firearms.
Ø Documentation:
· Child files: LPAS observed 4 children's files contained all required licensing documents.
· CPR/First Aid: LPAS observed licensee has current Pediatric CPR and First Aid Training with an expiration date (of 09/2021) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Criminal Record: Pre Guardian, all adults who live in this facility obtain a criminal record clearance.
· Facility fees: Per Licensing Information System, facility annual fees were current.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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: 11/09/2022
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· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 10/20/2020.
· Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP). The licensee and her assistant provided a written statement declining the influenza vaccination.
· Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPAS observed 3 infants have LIC 9227 and the Sleeping log is also in each infant’s file
· The licensee has posted as required the Facility License, Emergency Disaster plan, Earthquake Preparedness, and Parent's Rights Poster
· Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 8/15/2021
· Staff Personnel File: LPAS observed 1 staff information. LPAS observed LIC 508, 9052, IZ, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. The file contained all required licensing documents.
· Staffing Ratio and Capacity: This is a large family childcare facility. LPAS observed 1 infant during the inspection.

Ø The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all times.
ü Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü The licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 11/09/2022
NARRATIVE
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ü The 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
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü Criminal Record Statement: Licensee [or facility representative] 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 the 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.
ü Safe Sleep: LPAS discussed the safe sleep regulations with the licensee [or facility representative] 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. LPAS also informed the licensee [facility representative] 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.
ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
ü Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
ü Type A citation: LPAS (name of analyst) informed licensee [or facility representative] (include name) that this report dated (insert visit date) document(s) (number of Type A citation) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPAS (name of analyst) informed the licensee [or facility representative] to provide a copy of this licensing report dated (insert visit date) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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: 11/09/2022
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ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day 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.
ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

ü LPAS provided consultation during the inspection.

No deficiencies are being cited at this time, the facility complies with Title 22


Exit interview conducted and the report was reviewed with the licensee Ana Peralta Garcia

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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