197700060-3-29-2023-12-CC-JDMO-CQDRUC-20230329131942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700060
Report Date: 03/29/2023
Date Signed: 03/29/2023 01:20:01 PM

Document Has Been Signed on 03/29/2023 01:20 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:	FOSTER FAMILY CHILD CARE		FACILITY NUMBER:	197700060
ADMINISTRATOR:	FOSTER, TECOLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 390-8007
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 2	DATE:	03/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Tecola Foster		TIME COMPLETED:	01:20 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 03/29/2023, at 9:20 a.m., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at the Foster Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements. LPA Del Mundo met with Licensee, Tecola Foster and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: Living room, den, dining area, hallway bathroom and outdoor play area (rear yard). Licensee states the day care hours of operation is Monday to Friday, 6:00 a.m. to 6:30 p.m. Currently living in the home is licensee, licensee's spouse and 3 children (16, 11 and 6). Licensee is providing transportation to children in care. During this visit, LPA observed three children present in the facility. Physical Plant The facility is a two story house. The home is clean and orderly, with heating and ventilation for safety and comfort, maintains a telephone service, (Licensee was advised that the cell phone shall be charged and available during day care hours) has children books, safe age-appropriate toys, play equipment and materials for children in care to use. Licensee has 13 cots available for napping children. At the time of this inspection, there are no fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission. Per Licensee, she provides food (breakfast and lunch) for children in care. LPAs 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.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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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Document Has Been Signed on 03/29/2023 01:20 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: FOSTER FAMILY CHILD CARE	FACILITY NUMBER: 197700060
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1796.45

(a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee's assistant #2 do have TB Skin Test on file and did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee will email a copy of the TB skin test of Assistant #2 to LPA.

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: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/29/2023 01:20 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: FOSTER FAMILY CHILD CARE	FACILITY NUMBER: 197700060
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2023

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 record review, the licensee's Assistants #1 and #2 do not have immunization records on measles, pertussis and influenza and did not comply with the section cited above which posed a potential Health, Safety or Personal Rights risk to persons in care.
	POC Due Date: 04/21/2023
	Plan of Correction
1 2 3 4	Licensee will email copies of immunization records on measles, pertussis and influenza of Assistants #1 and #2 to LPA.

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: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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: FOSTER FAMILY CHILD CARE	FACILITY NUMBER: 197700060
	VISIT DATE: 03/29/2023

NARRATIVE

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The home is free from defects or conditions which might endanger a child. There is no fireplace in the facility. It has operational carbon monoxide, smoke detector and fire extinguisher which meet established standards and a service date on 12/2022. Poisons, detergents, cleaning compounds are stored in the utility closet where they are locked and inaccessible to children. Medicines are stored in the upstairs bathroom (off limits). Licensee has two first aid kit box located in the upper shelve of the entrance door and in bathroom #1. Per licensee, there are no firearms in the facility. Licensee is advised that all children, age and ability permitting, and the provider, the assistant provider (if any), and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted (date 11/23/2022) once every two or three months, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility. Licensee is aware that smoking is prohibited on the premises of a family child care home.

Currently, there are eleven children enrolled in their program. Per licensee, the youngest child enrolled is 26 months. For infants enrolled, licensee is aware that there must be one crib or play yard for each infant who is unable to climb out of the crib or play yard. The crib(s) or play yards use by the facility must meet the United States Consumer Product Safety Commission safety standards. Placement of crib(s or play yards shall not hinder entrance or exit to and from the space where infants sleep. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. The mattresses shall be made specifically for the size crib or play yard in which they are placed.

The facility has no body of water on the premises. The rear yard is properly fenced and supervised by the licensee. The air-conditioning fan unit located in the rear yard has a metal fence to make it inaccessible to children in care. Per licensee, aside from the metal fence barricading the right side of the outdoor play area, wooden fence is also being attached as support to the current metal fence. LPA also observed sand box in the outdoor play area. The LPA also explained to Licensee how to obtain information from the Community Care Licensing (CCL) website (www.cdss.ca.gov).

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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: FOSTER FAMILY CHILD CARE	FACILITY NUMBER: 197700060
	VISIT DATE: 03/29/2023

NARRATIVE

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Care and Supervision
Per Licensee, she is present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences do not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she is separated from other children in the living room.

Facility Administration
The licensee and assistants have current mandated reporter training certificate with an expiry date of 11/30/2022. The Licensee and assistants have current Pediatric CPR and First Aid training certificate which expires on 05, 06 and 10 of the current year. Licensee has proof of immunizations against influenza and pertussis except for measles. Licensee has TB skin test on file. However, licensee’s spouse (assistant #1 lacks immunization records on measles, pertussis and influenza, On the other hand, assistant #2 has no immunization records and TB skin test. Licensee and/or assistants were advise to take the preventive health practices training that includes nutrition and lead poisoning. At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

Licensee is aware that personnel records should be maintained on Licensee and each assistant (if any) and contain the following information: Licensee and staff full name; A signed and dated copy of the Notice of Employee Rights [LIC 9052]; Driver's license number if the employee is to transport children; Date of employment; Date of birth; Current home address and phone number; Documentation of completion of training on preventative health practices as required by Section

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

Page: 6 of 6

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: FOSTER FAMILY CHILD CARE	FACILITY NUMBER: 197700060
	VISIT DATE: 03/29/2023

NARRATIVE

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Pg 4
102416(c). Any changes to the facility from an area of the family child care home should be reported to the Department.
Records

Licensee and other adults living in the home, working at and associated to the facility have received criminal record clearance.

Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

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

The Facility is not in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo observed deficiencies that may hinder the health and safety of the children in care. Deficiencies were cited during inspection. An exit Interview and discussion of observations were conducted with the licensee. A copy of this Report was reviewed, Notice of Site Visit (LIC 9213) and Appeal Rights were provided to Licensee, Tecola Foster.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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