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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700076
Report Date: 10/31/2019
Date Signed: 10/31/2019 03:26:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:SERRANO FAMILY CHILD CAREFACILITY NUMBER:
197700076
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
10/31/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Tomasa SerranoTIME COMPLETED:
03:31 PM
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On 10/31/19 at 1: 30 p.m., Licensing Program Analyst (LPA) Isabel Ortega was greeted by above facility's licensee, Tomasa Serrano. LPA was at the facility to conduct an unannounced case management inspection as licensee is requesting to move the child care area to an addition room to the home. City permit was approved by the City of Santa Clarita and copy was submitted to the Palmdale Regional Office. LPA disclosed the purpose of the inspection and was granted entry by the licensee, who guided LPA on a tour of the facility. Upon entry LPA observed 6 children in care.

Residing in the residence includes licensee, two adults and her two minor children. All adults who reside in the home have been background cleared.



LPA toured the facility, inside and out and the following was observed and recommended:

Main care will be provided in the new constructed additional room with a restroom and kitchen(ADU) which is designated as the main playroom area. LPA observed several age appropriate toys and furniture in good condition.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 10/31/2019
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LPA observed a working smoke detector and carbon monoxide detector that meet fire marshal standards (tested at 2:15 p.m.). A fully charged 2A10BC fire extinguisher was observed and in operational condition. There is a working telephone and first aid kit on premises. The playroom (ADU) is well ventilated. Licensee will complete moving day care materials and set up playroom area which include adding a support step existing the restroom. Also, the restroom that will be utilized by children has a glass shower door, which licensee agreed to add a safety lock making it inaccessible to children. The kitchen area will need to be barricaded by a child safety gate or adding child safety knobs and safety latches to the stove and cabinets. The outdoor side pathway leading to the back yard will need to be cleared of any hazards and approved prior to use. Once all correction have been made Licensee will contact the Palmdale Regional Office to request approval. Licensee will be submitting an application for increase of capacity to a large FCC.

Per licensee there are no fire arms or weapons on premises. LPA did not observe any fire arms nor weapons. No pools or bodies of water were observed to be on premises.

An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee. Appeal rights were provided and discussed with licensee Tomasa Serrano.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2019
LIC809 (FAS) - (06/04)
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