197700188-5-17-2023-12-CC-AALH-CRWNYG-20230517105243

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700188
Report Date: 05/17/2023
Date Signed: 05/17/2023 10:53:06 AM

Document Has Been Signed on 05/17/2023 10:53 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:	JENSEN FAMILY CHILD CARE		FACILITY NUMBER:	197700188
ADMINISTRATOR:	JENSEN, CAROLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 305-8760
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 3	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Licensee Carole Jensen		TIME COMPLETED:	11:10 AM

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On 05/17/2023 Licensing Program Analyst (LPA) Andrew Alemoh, met with licensee, Carole Jensen who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPA observed 3 children in care and licensee caring for them. Family members residing in the home include 4 adults (licensee, licensee's husband, licensee older son and daughter and two minors children). Facility hours of operation are Monday - Friday 8:30AM- 12PM. Incidental Medical Services (IMS) policy was discussed.

There is a pool on the premises .

Physical Plant: Main care is provided in the playroom area. There is an area for the day care children to place their backpacks and belongings. A fish tank is located in the playroom area. LPA observed educational materials such as: books, toys and arts and crafts. Per licensee she provides water to children. LPA observed water cups with children names on them for the day care children. The children use the bathroom located in the licensee bedroom. There is a temporary bathroom in the garage for the day care children to utilize if necessary. The off-limits areas are 3 bedrooms, second restroom, kitchen and living room area. Laundry room and garage are also off limits and are kept locked during business hours.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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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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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 197700188
	VISIT DATE: 05/17/2023

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The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept underneath the kitchen sink, medicines are kept in the upper cabinet in the kitchen and hazardous items (sharp knives are kept in the off limits garage) .

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (3A40BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the play room area. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 04/27/2023. LPA observed the double sided fireplace located in the off-limits living room area to be fully barricaded by a nailed in the wall board. LPA observed the child care home roster to be complete and current.

Bathroom: Children use licensee bathroom. Toilet and faucet are clean and operable. LPA did not observe any prohibited items in the children's bathroom. There is a temporary bathroom the children may use in the garage depending on the circumstances of the main children bathroom. LPA observed the temporary bathroom to be clean. Toilet and faucet are clean and operable. LPA did not observe any prohibited items in the temporary bathroom. LPA observed licensee properly storing two cleaning compounds in a cabinet secured with a safety latch. Toilet and faucet are clean and operable.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 197700188
	VISIT DATE: 05/17/2023

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Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are underneath the kitchen sink which is locked with a safety latch. Lunch and snacks are provided. Licensee stated she currently does not have a food program. There are no naps due to the hours of operation.

Outdoor: The front yard is off limits. The backyard is completely fenced in with an iron fence. There is an alarm system on the backyard door. There are two dogs and four cats on the premises. LPA observed age appropriate toys, well secured and safe for children. There is a play structure in the backyard that sturdy, safe and age appropriate for children. LPA observed the sandbox in the backyard. There is a entrance gate on the left and right side of the backyard. Per licensee the gates remain locked at all times. LPA observed the gates to be locked. The BBQ pit was observed to be fully covered. There are 4 sheds in the backyard that are locked during business hours. Per licensee the sheds contacts storage for Christmas supplies, plane supplies,

There is a swimming pool and a spa in the backyard. The bodies of water are completely enclosed by a 5 ft mesh fence. The fence runs all the way down to the concrete on which it sits, leaving no room between the bottom of the fence and the concrete. The pool gate was tested and observed to be self-closing and self-latching. The gate has an installed mechanism containing a key to lock the gate and it is located within 6 inches from the top of the gate. The lever to open the gate is located at the top of the gate. The pool gate opens away from the body of water. All items rendering the fence climbable are moved away from the fence. The mesh fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. LPA took photos to document in the file.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 197700188
	VISIT DATE: 05/17/2023

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Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 01/25/25. Mandated Reporter expires on 03/09/2024 LPA reminded licensee; mandated reporter training must be completed every 2 years.

Licensee Carole 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.

LPA discussed the safe sleep regulations with licensee Carole 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.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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