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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700184
Report Date: 06/29/2021
Date Signed: 06/29/2021 12:27:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:FONSECA, JAIME FAMILY CHILD CAREFACILITY NUMBER:
197700184
ADMINISTRATOR:FONSECA, JAIMEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 675-8156
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 3DATE:
06/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jaime FonsecaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) King-Lewis conducted a required 1 year Inspection with licensee Jaime Fonseca, who guided analyst on a tour of the license day-care. The day care take place in the following area of the home: large family room/playroom, rear yard and hall way bathroom. Days/hours of operation varies, most children come from 6:00 AM to 7:00 PM but sometime time child 1 will spend the night depending on mother' schedule. Licensee stated will operate as needed but less than 24 hours. Family member living in the home are the licensee, Jessica Cardenas, and 5 minor children (15, 13, 11, 8, 1)

Physical Plant: There is a locked spa on the premises in the rear yard. Licensee stated there are no firearms or other dangerous weapons. storage areas for poisons shall be inaccessible to children and locked. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are inaccessible to children stored in top kitchen cabinet secured with a kiddy lock locked garage and in licensee bedroom. No Fireplace available. fire extinguishers, smoke detectors, and carbon monoxide appear to be operable. LPA observed the home to be clean and orderly, central air and heating available. no stairs to barricade this is a single story home. Licensee stated cell phone are always available and charged, during day-care hours. there are two roll cribs for infants use, with firm mattress, licensee was provided the safe sleep regulations and read requirements during this visit. Licensee aware when infants are present the crib shall be free from all loose articles and objects.



Care and Supervision
Licensee is aware he must be present in the home and shall ensure that children in care are
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FONSECA, JAIME FAMILY CHILD CARE
FACILITY NUMBER: 197700184
VISIT DATE: 06/29/2021
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supervised at all times. Licensee stated transportation is provided when school is in session and when the day care takes field trips. LPA informed licensee to make sure the transportation vehicle is proper insured to transport day care children. Licensee is aware the capacity stated on the facility license shall be the maximum number of children being cared for at one time. Licensee aware no infant shall be swaddled and car seat shall not be use for sleeping. Licensee is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the child status. Licensee should refer to regulation 102425(J) for documentation requirement. LPA reviewed requirement with licensee during this inspection visit.

Facility Records Review
LPA observed facility current roster of children, current fire and disaster drill, current mandated reporter expires June 2023, licensee immunization are current and licensee is aware that all employees or volunteer at the day-care shall be immunized against pertussis and measles and maybe immunized against influenza. Licensee is aware all infants shall have an individual infant Sleeping Plan (LIC 9227).

Facility Administration
Licensee aware to immediately remove individual and prevent individual for returning to the home or having contact with children in care upon notice from the department to remove an individual and all individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in the license home. Licensee is aware any authorized employee of the Department may enter and inspect any place providing personal care and services at any time with or without advance notice. Licensee is aware other personnel shall complete training on preventive health practices including CPR and first aid per regulation 102416 (c).

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FONSECA, JAIME FAMILY CHILD CARE
FACILITY NUMBER: 197700184
VISIT DATE: 06/29/2021
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During this inspection facility was observed to be in compliance with Title 22.

An exit interview was conducted, and a copy of this report and the notice of site visit, provided to licensee on this date.

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

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3