197700010-4-17-2024-12-CC-AVIA-D4EQ6U-20240417115406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700010
Report Date: 04/17/2024
Date Signed: 04/17/2024 11:54:18 AM

Document Has Been Signed on 04/17/2024 11:54 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	WARREN FAMILY CHILD CARE		FACILITY NUMBER:	197700010
ADMINISTRATOR:	QUINTINA WARREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 485-6021
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 1	DATE:	04/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Shania Brown		TIME COMPLETED:	01:00 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

On April 17, 2024, Licensing Program Analysts (LPA) Annelise Villa met with assistant Shania Brown who guided analyst on a tour of the facility for the random annual inspection. Upon arrival, LPA observed 1 preschool age child with the assistant caring for them. Family members living in the home are Licensee, Licensee’s 2 adult children. Hours of operation are 6:00 am to 6:00 pm. Incidental Medical Services (IMS) policy was discussed. No children in the daycare with IMS.

Physical Plant: This is a one-story 3 bedrooms, 2 bathrooms home with kitchen, living room, front/back yards, laundry room, and garage. The attached garage was observed to be locked during the time of this inspection. The garage is used for storage only and is garage is off limits to children. Main care is provided in the living room. Children have access to the living room, kitchen bathroom #1, and back yard. The off-limits include all upstairs areas including bedrooms 1-3, bathroom #2, laundry room, garage, and front yard. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, and medicines. Hazardous items (sharp knives are located in an upper kitchen cabinet, cleaning detergents/compounds are stored in an upper kitchen cabinet, and medications are stored in an off limits area and inaccessible to children in care.)

Safe and age-appropriate toys, play equipment and materials were observed. LPA tested the smoke detector and carbon monoxide detector and observed both to be in operable condition. Fire extinguisher (3A40BC) was found to be in operable condition (in the green) located in the kitchen. Electrical outlets were inaccessible. No recalled and or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary.

Bathroom: Bathroom #1 located on the right side of the hallway. The toilet and sink are in operable condition. LPA did not observe any hazardous material in the bathroom. LPA reminded applicant the children's bathroom must be free of accessible shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover.

Continued on LIC 809-C

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

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 4

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 197700010
	VISIT DATE: 04/17/2024

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: The kitchen was observed to be clean and orderly. Sharp utensils are stored in an upper kitchen cabinet and inaccessible to children in care. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, and snacks are provided. Assistant stated the facility is a participant in a food program.

Outdoor: Children play in the back yard. LPA toured the back yard and observed it to be free of garden tools, poisonous plants, thorn trees, cactus, or lawn mower inaccessible to children. The play area is clear and clean of debris, play area is fenced and gated all around. There is a jungle gym in the back yard with wooden chips used for padding. LPA observed age-appropriate play equipment for children.

Pools/Spas/Bodies of Water: There are no pools, spas, or bodies of water on the premises.

Advisory/Other: First Aid kit was observed in the living room closet with supplies readily available. Licensee’s First Aid/CPR is valid and expires on 12/2024. Licensee’s Mandated Reporter training expired on 3/2023. Licensee shall retake mandated reporter training at www.mandatedreporterca.com and send proof of completion to LPA Villa no later than 4/22/2024. Assistant's CPR/First Aid is valid and expires on 8/2024. Assistant's Mandated Reporter training is valid and expires on 12/2024. LPA reminded assistant mandated reporter training and CPR must be completed every 2 years. Per Assistant, there is no smoking in the home. Per Assistant there are no pets on the premises. Per Assistant there are no guns, weapons, or firearms in the home. Additionally, Assistant confirmed there is no smoking of any kind in the home. Last fire/disaster drill was completed on 11/10/2023.

Licensee’s annual fees are current. LPA observed all required facility postings on premises. Licensee had the following required posted documents: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203) and Emergency Disaster Plan (LIC 610A), and Fire/Disaster Log.

Documents Provided and or Discussed: Earthquake Preparedness Checklist (LIC 9148), Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227).

Licensee 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.

Continued on LIC 809-C

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 197700010
	VISIT DATE: 04/17/2024

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

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov. 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep. More information on Infant Safe Sleep procedures can be found online on the CDSS web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

Continued on LIC 809-C

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 197700010
	VISIT DATE: 04/17/2024

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

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Exit interview conducted, and report was reviewed with the licensee. A notice of site visit was given and must remain posted for 30 days. No citation was given today as a result of this inspection.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4