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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700184
Report Date: 12/20/2019
Date Signed: 12/20/2019 02:33:17 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:FONSECA, JAIME FAMILY CHILD CAREFACILITY NUMBER:
197700184
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
12/20/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Jamie FonsecaTIME COMPLETED:
02:49 PM
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Licensing Program Analyst (LPA), Lady King-Lewis met with licensee for the purpose of a capacity increase visit. Licensee was initially licensed on 07-09-18 as a small FCCH. Licensee meets the qualification to increase the capacity to a large FCCH. A fire clearance has been received and approved.

Present during the visit was the licensee, licensee's finance' and two minor children. No day care children present.

The home consists of 6 bedrooms, 3 bathroom, den, family room, dining area, kitchen, backyard, attached garage, and detached garage. Family members residing in the home include the licensee, licensee's finance', one adult female, 5 minor ( 3 months, 6, 10, 12, and 14 years of age.)

Main care is provided in the family room, dining area, front entry bathroom and backyard.

Off limit areas include all bedrooms, front den, hallway bathroom, master bathroom, the attached and detached garage. There is a safety gate upon entry to the off limit area. The den doors locks to make the area inaccessible to children in care. The garages are used for storage only. No child care activities are conducted in the garages.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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 3
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: FONSECA, JAIME FAMILY CHILD CARE
FACILITY NUMBER: 197700184
VISIT DATE: 12/20/2019
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The facility Licensee, Notification of Parents’ Rights Poster, and Emergency Disaster Plan are posted. Pediatric CPR and First Aid will expire on 05-08-20

The home was inspected 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. Knives are stored in top kitchen cabinet. Cleaning supplies are stored in the kitchen sink cabinet with a safety latches.

There are age appropriate toys and equipment on the premises. Appropriate fire extinguisher (2A10BC) is mounted on the family room wall. Smoke detectors and Carbon Monoxide detector are in operable condition. The home does not have a fireplace. Home is equipped with central Air conditioning and Central heating. There is a spa in backyard with a secure lock cover. Licensee stated there are no firearms or weapons of any kind in the facility. LPA did no observe any weapons or fire arms. First aid kit was observed and complete. LPA reviewed the requirements for children's files.

Children have access to the backyard. The backyard is fenced. A dog run is on the garage side of the home. The fenced outside play area is free from defects or dangerous conditions. Play equipment is securely anchored. LPA observed a trampoline in the backyard play area. LPA informed Licensee that the trampoline should be used as the instruction states and age appropriateness. LPA inform licensee of the injuries, trampoline have caused when it is not used properly.

Licensee is reminded that with a capacity increase, he must have a qualified assistant present whenever there are more than 8 children in care. Licensee is also reminded that with
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FONSECA, JAIME FAMILY CHILD CARE
FACILITY NUMBER: 197700184
VISIT DATE: 12/20/2019
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the capacity increase to a total of 14 children he is to have no more than 3 infants in care (0-2yrs), 1 child enrolled in Kindergarten, 1 child at least 6 years of age and a qualified assistant.

The following were discussed: No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category. Licensee was also reminded of incident/medication documentation (notify the Department of any unusual incidents/injury that occur at the home, via the phone within 24 hours and within 7 days written format).

Licensee understands that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). Never shake a baby to prevent Shaken Baby Syndrome. Licensee was also reminded children may only be in high chairs if they are eating. Children shall not be left in car seats or strollers while in care. Children shall not be left alone while napping. LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements. Fingerprint clearance and transfer process. Capacity and ratio and reporting requirements.

No deficiencies were observed during this inspection. The Notice of Site Visit form must be posted along with a copy of the report for 30-days, must be visible to parent.

An exit interview conducted and copy of this report was provided to licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3