197700033-10-4-2023-12-CC-APIN-CWAVB5-20231004161657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700033
Report Date: 10/04/2023
Date Signed: 10/04/2023 04:17:10 PM

Document Has Been Signed on 10/04/2023 04:17 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:	SILVA AND SILVA FAMILY CHILD CARE		FACILITY NUMBER:	197700033
ADMINISTRATOR:	KUMUDUNI SILVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 723-5230
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	14	CENSUS: 8	DATE:	10/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Licensee Janaka & Kumuduni Silva		TIME COMPLETED:	04:35 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 10/4/2023 at 11:22am, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observed 8 children in care and two staff providing care and supervision (fingerprint cleared and associated to the center.) The co-Licensee later joined the inspection and completed the inspection with licensing. The operational childcare hours are Monday through Sunday varied up to 23 hours depending on family's need. This is a two-story family home. There is a living room, family room, classroom, kitchen, four bedrooms, three bathrooms, laundry area, backyard, and attached garage but made inaccessible from inside the home with a safety knob. Licensee does provide napping: 1 crib, 4 playpens, and 15 mats. The off-limits areas are all four upstairs bedrooms, two upstairs bathrooms, laundry area, and garage. Licensee provides breakfast, lunch, dinner, and snacks; children are permitted to bring food from home and it is properly labeled and placed in a refrigerator for the childcare. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed that the stairs leading to off-limits area upstairs does not have an installed baby gate. The Licensee stated that the baby gate had broken this morning and he was unable to repair it and replace it. This is a Type B violation, see the LIC 809D for the details. Hanging window blind cords: The cords are inaccessible to children. Pets: there are no pets on premises. Phone service: There is a working landline and cell phone, charged and kept on staff at all times. Transportation: The Licensee does provide transportation for children, the Driver’s License expires in 1/2027, the insurance carrier is AAA and expires in 2/2024, and the vehicle: 2018 Toyota Highlander is registered. Continue to next page

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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

FACILITY NAME: SILVA AND SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 10/04/2023

NARRATIVE

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Knives are kept in the off-limits garage, inaccessible to children in care. Medication is kept in the off-limits garage, inaccessible to children in care. Cleaning supplies and chemicals are kept inaccessible under the kitchen sink with a safety latch, away from children in care.

There are age-appropriate toys and equipment on the premises. LPA observed the outdoor area for damaged objects, broken toys/furniture & equipment, and other debris; LPA found that the smaller climbing structure pink slide was cracked, the Licensee removed the climbing structure making it inaccessible to children in care. Additionally, LPA observed a broken child’s swing, the Licensee made the swing inaccessible by placing it in an inaccessible area. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons. Per the Licensee, there is no smoking on the premises. There are no open bodies of water on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept in a closet in the living room with a safety knob. The required fire extinguisher (2A10BC) is reading in green, last tested on 6/22/2023. Smoke and carbon monoxide detectors were found to be in operable condition, tested at 11:42a.m and 11:41am, respectively; and the fire pull is installed and operational. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 6/9/2023 at 3:30pm for Fire and/or Earthquake/Disaster Drill.
Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Licensee does not have insurance coverage for the facility and provides parents the LIC 282-Affidavit Regarding Liability Insurance for Family Child Care Homes.

The Licensee provided proof of immunization against pertussis (TDAP), measles (MMR), TB, and statement declining the Influenza for self and their spouse who is the co-licensee; however, the MMR vaccine is missing for Staff 1, this is a technical violation.

Personnel Records: Licensee was able to provide a valid Pediatric CPR/First Aid training valid until 5/2024 and 12/2023 for the Licensees; however, Staff 1 does not have their current Pediatric CPR/First Aid training which is a Type B violation, see the LIC 809D for the details. Child Care Provider Mandated Reporter Training Certificate has been completed and valid until 2024 for the Licensees; however, Staff 1 does not have their renewed Mandated Reporter, this is a Type B violation, see LIC 809D for the details. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, and background clearances.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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

FACILITY NAME: SILVA AND SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 10/04/2023

NARRATIVE

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Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, and CDPH 286-California School Immunization Record. Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative 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.

The Licensee was reminded 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 Licensee was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative 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 the 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. Provided Licensee with an Infant Sleep Plan form LIC 9227 and the sleep log.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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

FACILITY NAME: SILVA AND SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 10/04/2023

NARRATIVE

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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-

CCP. 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/.

Facility Representative 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.

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

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.

The licensee was informed of their responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is not in compliance, two Type B Deficiencies have been cited. Please, see the LIC 809D for the citations. All licensing reports are recommended to be kept for 3 years.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Facility Representative.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/04/2023 04:17 PM - It Cannot Be Edited

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: SILVA AND SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(3)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above the stairs leading to the off-limit upstairs area were not fenced or barricaded while children under 5 were in care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/18/2023
	Plan of Correction
1 2 3 4	Licensee will replace the broken gate that barricaded the stairs and will e-mail the proof of correction no later than 10/18/2023.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above as Staff 1 did not renew their Mandated Reporter Training before expiration which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/18/2023
	Plan of Correction
1 2 3 4	Licensee will have Staff 1 complete the Mandated Reporter Training and e-mail the certificate no later than 10/18/2023

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	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

Document Has Been Signed on 10/04/2023 04:17 PM - It Cannot Be Edited

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: SILVA AND SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above by not having Staff 1 renew their Pediatric CPR & First Aid Training and taking the Preventative Health Training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/18/2023
	Plan of Correction
1 2 3 4	Licensee will have Staff 1 complete the Pediatric CPR & First Training and the Preventative Health Training and e-mail the certificate no later than 10/18/2023

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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