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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700230
Report Date: 02/16/2022
Date Signed: 02/16/2022 11:09:07 AM


Document Has Been Signed on 02/16/2022 11:09 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SAMUDIO FAMILY CHILD CAREFACILITY NUMBER:
197700230
ADMINISTRATOR:SAMUDIO, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 204-1069
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 2DATE:
02/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Maria Veronica SamudioTIME COMPLETED:
11:23 AM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Maria Veronica Samudio, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 5 bedroom, 3 bathroom home with kitchen, dining room (converted to daycare), family room, living room, laundry and garage. There is a pool on the premises. Upon arrival LPA observed 3 children.

Physical Plant: Main care is provided in the converted dining room, living room and family room. Children use the bathroom in hallway near the laundry room. Children have access to the dining room, living room, family room and the kitchen. Off limit areas include the entire upstairs, laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under the sink), medicines (cabinet above the stove) and hazardous items (sharp knives inaccessible on the counter) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Stairs have a gate. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any 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 living room. Per Licensee there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 07/07/21, LPA advised licensee to conduct a disaster drill every six months. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2022
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 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: SAMUDIO FAMILY CHILD CARE
FACILITY NUMBER: 197700230
VISIT DATE: 02/16/2022
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Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked under the sink. No chemicals in the kitchen were observed to be accessible. Breakfast, AM snack, lunch, PM snack and dinner are provided.

Outdoor: The backyard is safe for children The backyard is completely fenced. The home was licensed with a fenced in ground pool. The backyard has grass and concrete areas for children to play. LPA observed the toys in the backyard to be in safe condition. The backyard also has a fenced off-limits area on the left side of the home where two dogs are kept.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 01/25/23, Per licensee the CPR course was taken online during the pandemic. LPA advised licensee to re-take the course in person and send proof to LPA. Mandated Reporter was completed 03/04/21. Child nap on mats in the main care area (converted dining room).

Documents discussed: Safe Sleep PIN 20-24-CCP and Large Family Child Care ratios.

Licensee Samudio 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 Samudio and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Samudio 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.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022
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: SAMUDIO FAMILY CHILD CARE
FACILITY NUMBER: 197700230
VISIT DATE: 02/16/2022
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A notice of site visit was given 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 Maria Veronica Samudio.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3