197700050-6-12-2024-12-CC-APIN-D66RU3-20240612131916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700050
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:19:29 PM

Document Has Been Signed on 06/12/2024 01:19 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:	DE SILVA FAMILY CHILD CARE		FACILITY NUMBER:	197700050
ADMINISTRATOR:	DE SILVA, YAMUNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 400-5271
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	14	CENSUS:	DATE:	06/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Licensee Yamuna De Silva		TIME COMPLETED:	01:45 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 6/12/2024 at 10:40am, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual 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 observe 4 children in care and the Licensee providing care and supervision. The operational childcare hours are Monday through Friday, 7:00am to 5:00pm, ages 18 months to 13 years old. This is a one-story family home. There is a living room, kitchen, four bedrooms, two bathrooms, laundry area, and attached garage but not accessible from inside the home as the door is locked and through the locked laundry area. Licensee does provide napping, there are 15 cots and two cribs. The off-limits areas are two bedrooms, 2^nd bathroom, laundry area, and garage. The first bedroom which was supposed to be off-limits was open and accessible, the Licensee was provided technical assistance on ensuring that off-limit areas must be made physically inaccessible. Licensee provides snacks, breakfast, and lunch, the Licensee is aware to properly label and refrigerate any meals brought from home. 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. Outlets: there was a wall outlet in the Licensee’s office and in the hallway that did not have outlet covers, the Licensee was provided technical assistance to ensure that they cover all unused outlets when not in use and during operational hours. Hanging window blind cords: The cords are inaccessible to children. Pets: there is one dog on premises, the Licensee attests the dog is fully vaccinated and is aware they must keep those records on file. Phone service: There is a working landline and cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does not provide transportation for children. Isolation occurs in the on-limit bedroom for children in care showing signs of illness. The calming area is located in the Licensee’s office. There is a fireplace that is screened and inaccessible to children in care.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700050
	VISIT DATE: 06/12/2024

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Knives are kept in the kitchen in a cabinet drawer secured by a safety tab, inaccessible to children in care. Medication is kept in the office in an accessible cabinet, this is a Type B deficiency, see the LIC 809D for the details. The Licensee moved the medication to the locked cabinet in the office making the medication inaccessible to children in care. Cleaning supplies and chemicals are kept in the laundry room and under the kitchen sink, inaccessible to children in care.

There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. The Licensee was made aware of the AC unit in the outdoor unit not being inaccessible for the blades inside of the unit, this is a Type B violation, see the LIC 809D for the details. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons, firearms, or ammunition. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauze, adhesive tape, first aid manual, and cleansing pads/solution was observed to be complete and inaccessible to children kept high on the wall in the office. The required fire extinguisher (2A10BC) is reading in green, last tested on 6/28/2023. Smoke and carbon monoxide detectors were found to be in operating condition, tested at 11:00am and 10:59am, respectively. Fire and Disaster drills are conducted at least every six-month, last drills were recorded in 2023, the Licensee conducted a drill today during the visit at 11:11am.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), and the Emergency Disaster Plan (LIC 610A) but the PUB 269 Child Passenger Safety Law and Earthquake Preparedness Checklist (LIC 9148) were not on the board, LPA provided the missing documents and the Licensee posted them during the visit.

Licensee has insurance coverage for the facility from Tapco, expiring 7/3/2025.

The Licensee provided proof of immunization against pertussis (TDAP), measles (MMR), TB, and Influenza vaccination for self; however, the Licensee did not have proof of TB for their spouse, this is a Type B violation, see the LIC 809D for the details. Licensee was able to provide a valid CPR/First Aid training completed 6/24/2023 and expiring in 6/2025. Child Care Provider Mandated Reporter Training Certificate has been completed in 4/21/2023 and expiring 4/2025. Licensee did not have any staff personnel files.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700050
	VISIT DATE: 06/12/2024

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 PM 286-California School Immunization Record; however, the school enrollment records were missing for four school age children, this is a Type B violation, see the LIC 809D for the details.

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

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700050
	VISIT DATE: 06/12/2024

NARRATIVE

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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.

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 Licensee confirmed that there are no Registered Sex Offenders living in the facility and the RSO profile is completed in FAS.
Child Care Advocates:
To sign up for our Quarterly Updates, please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & call at (916) 654-1541.
The licensee was informed of the 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, four Type B Deficiencies have been cited. Please, see the LIC 809D for the citations. 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.All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2024 01:19 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: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700050
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)

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: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not making the ac unit inaccessible and the fan blades are accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/26/2024
	Plan of Correction
1 2 3 4	Licensee will e-mail proof of barricading or making the ac unit inaccessible to children in care no later than 6/26/2024.

Type B

Section Cited

CCR

102417(g)(4)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by having medication accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/26/2024
	Plan of Correction
1 2 3 4	Licensee will place the medication in an area that is inaccessible to children in care no later than 6/26/2024.

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: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2024 01:19 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: DE SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700050
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having proof of TB clearance for the spouse which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/26/2024
	Plan of Correction
1 2 3 4	The Licensee plans to e-mail the proof of TB clearance for their spouse no later than 6/26/2024.

Type B

Section Cited

CCR

102421(c)

Child's Records

(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having the school enrollment documents for the school age children enrolled which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/26/2024
	Plan of Correction
1 2 3 4	The Licensee plans to e-mail proof of the school enrollment forms for all children who are attending school no later than 6/26/2024.

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: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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