197700230-1-31-2023-12-CC-JDOY-CNLQML-20230131111742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700230
Report Date: 01/31/2023
Date Signed: 01/31/2023 11:18:31 AM

Document Has Been Signed on 01/31/2023 11:18 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 CARE		FACILITY NUMBER:	197700230
ADMINISTRATOR:	SAMUDIO, VERONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 204-1069
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	14	CENSUS: 0	DATE:	01/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Veronica Samudio		TIME COMPLETED:	11:32 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, 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 1 children in care. 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, downstairs bedroom, 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/microwave) and hazardous items (sharp knives inaccessible on the counter) that can pose a danger to children. 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. During the visit LPA Dorsey observed the home to have fireplaces in both the living room and family room. LPA observed the fireplace in the living room to not be barricaded, due to the fireplace in the living room being switch operated and have an open faced heater. LPA Dorsey advised the licensee to place the barricade covering the family room fireplace over the fireplace in the living room until another barricade is present. The last fire/earthquake drill was completed 01/04/23. 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 Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAMUDIO FAMILY CHILD CARE	FACILITY NUMBER: 197700230
	VISIT DATE: 01/31/2023

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Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner are provided. LPA reminded licensee 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.

Outdoor: 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 01/22/25. Mandated Reporter was completed 03/04/21. Children nap on mats in the dining room (when necessary) and the infant currently present sleeps in a crib in the family room.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

Licensee 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 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 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.

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 Veronica Samudio.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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