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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700076
Report Date: 11/02/2022
Date Signed: 11/03/2022 08:37:56 AM


Document Has Been Signed on 11/03/2022 08:37 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:SERRANO FAMILY CHILD CAREFACILITY NUMBER:
197700076
ADMINISTRATOR:SERRANO, TOMASAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 809-6722
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY:14CENSUS: 9DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tomasa SerranoTIME COMPLETED:
04:02 PM
NARRATIVE
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On 11/02/2022 Licensing Program Analysts (LPAs) Beneroso and Pittman met with licensee Tomasa Serrano , who guided analyst on a tour of the facility for the One Year Required inspection.
This is a single story family home which consists of three bedrooms, two bathrooms, a kitchen, dining area, and living room. The day care takes place in converted permitted garage (Day care area), bathroom located in day care area and rear yard. The backyard is completely fenced in. Children use the bathroom located to the right of the hallway. The front yard is used for outside play. The off limit areas include all three bedrooms, the master bathroom, laundry room, side yard, shed in the backyard and room constructed. There is no garage in the premises. The bedrooms and master bathroom are properly gated and made inaccessible to children. The side yard is inaccessible as it has a gate separating it from the area in which the children in care arebe using. The laundry room is made inaccessible by a child proof door knob. There is a pool that was observed to be made inaccessible by a mesh fencing that is five foot high with a gate that is self latching, self closing and opens away from the pool. There is also a gate that separate the pool from the front yard.

Upon arrival LPAs observed 9 children in care and 1 adults caring for them. The assistant arrived 20 minutes. Family members residing in the home include 3 adults (licensee, licensee's husband, and licensee's brother in law ) and 3 minor children. Facility operation hours are Monday - Friday 6AM- 5:30PM. Incidental Medical Services (IMS) policy was discussed.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 11/02/2022
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 There is an additional room that was build in the backyard by the pool that does not have a permit. Per licensee, the structure was built around May 2021. There is one uncleared adult, living in the unit for more than 5 days.

Fire/Disaster drills are maintained current. Last fire/disaster drills was completed on 11/02/2022.

Bathroom: LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. Per licensee, she currently has a food program breakfast, lunch and snacks are provided. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located in the kitchen which off limits . Breakfast, lunch, snacks are provided. Licensee stated she currently does have a food program. Naps are provided in mats in the child care area

Outdoor: The front yard is used by day care children. The backyard is completely fenced in and off limits; there is a pool that was observed to be made inaccessible by a mesh fencing that is over five foot high with a gate that is self latching, self closing and opens away from the pool. The pool is separated by a gate. LPAs observed age appropriate toys, as well as a storage shed that is locked. Per licensee, there is one dog on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expired 09/2019. Mandated Reporter expired on 02/12/2022. Licensee will complete the mandated reporter training at www.mandatedreporterca.com and submit proof of CPR/First aid via email it to LPA Beneroso for proof of completion by 11/03/2022. LPAs reminded licensee, mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have child care insurance.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 11/02/2022
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LPA discussed the safe sleep regulations with licensee Serrano and discussed the Child Care Licensing Safe Sleep 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.

Licensee Serrano 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.

LPAs observed an uncleared adult living in the premises, in the off limits areas. This poses an immediate health and safety risk to children in care. A type A citation will be assessed, as well as an immediate civil penalty of $500 will be assessed.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Serrano along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/03/2022 08:37 AM - 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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPAs observed an uncleared adult living in the premises, in the off limits areas. This poses an immediate health and safety risk to children in care. A type A citation will be assessed, as well as an immediate civil penalty of $500 will be assessed
POC Due Date: 11/03/2022
Plan of Correction
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LIicensee will provide proof of uncleared adult by no later than 11/03/2022
Type A
Section Cited
CCR
102416.5(d)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the License was providing care to nine children which exceeds the staffing ratio and capacity for a small family child care home. This poses an immediate Health, Safety or personal right risk to the children in care.
POC Due Date: 11/02/2022
Plan of Correction
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LPAs observed assistant arrive at facility within 30 minutes.

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 RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4