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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700259
Report Date: 06/19/2021
Date Signed: 06/30/2021 09:29:33 AM

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:BERNABE FAMILY CHILD CAREFACILITY NUMBER:
197700259
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/19/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Michele BernabeTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Carol Heath conducted an announced pre licensing capacity increase inspection. Upon arrival the LPA met with licensee Michele Bernabe who guided the LPA on a tour of the facility. Individuals that reside in the home are the licensee Michele Bernabe, her adult son Jonathan Bernabe and daughter Astrid Bernabe. Per licensee the hours of operation are Monday through Friday 6:30 AM to 6:00 PM.

The Home is et up as follows:
This is a single-family two story home. The first floor consists of a dining room, front room/children's playroom, kitchen, one bedroom, one full bathroom, and an attached garage. The second floor consists of three bedrooms, two bathrooms, and a laundry room. The off-limits areas are the garage, and the entire second floor. The home will utilize the backyard for outside play. The backyard is gated all around. Main care will be provided in the front room/children's playroom.

· Main Area:

Living/Dining Room: There is a fireplace located in the Living room. LPA observed a toy storage unit with bins in front the fireplace which is made inaccessible to children. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs and debris. Hanging window blinds cords are inaccessible to children. LPA observed many age appropriate toys, books and other materials. Per applicant, the children will nap in the Living/Dining room area.
Bathroom #1: Bathrooms were toured, and inspected sink/toilet are in operable condition. Toilet and faucets are clean, safe and operable. All poison and medications are made inaccessible to children with child safety latches on sink cabinet. Children will use this bathroom located in the hallway.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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: BERNABE FAMILY CHILD CARE
FACILITY NUMBER: 197700259
VISIT DATE: 06/19/2021
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Bedroom #1 (Infant Room): LPA Heath observed 2 cribs. LPA observed 10 napping equipment (cots) in the closet.

Backyard: The backyard was inspected; the backyard is clean and free from all debris. The backyard is fully fenced. There is no body of water on the premises.

Kitchen (Child safety gate): LPA observed all sharp utensils and cutlery, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are made inaccessible to children. Sharp knives are inaccessible to children stored in the off-limits garage. The refrigerator dishwasher, stove, microwave, etc., are clean.

AC/Heating Unit was observed. LPA observed sharp blades is accessible to the children there is no cover on top of the system to prevent children from accessing the unit.

· Off-limit area (LPA observed and inspected the off-limit areas)

LPA observed 2 safety gates to make the stairs inaccessible to the children to the second floor.

Bedrooms (Safety gate): Bedroom #2, Bedroom #3 and Master Bedroom.

Garage / Laundry room (Safety doorknob): LPA observed extra children toys and materials in the garage. Laundry clean supplies are made inaccessible to children.

Napping: Children will nap in the designated nap areas with adult supervision.

Age appropriate toys and equipment: The home has age appropriate toys, play equipment and materials.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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: BERNABE FAMILY CHILD CARE
FACILITY NUMBER: 197700259
VISIT DATE: 06/19/2021
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The first Aid kit is located in the kitchen inaccessible to children on top of the refrigerator.
Electrical outlets: All unused electrical outlets are plugged and made inaccessible to children.
Bodies of water: There are no bodies of water in the home.
Medications and cleaning solutions are stored in locked cabinets in the off-limits laundry room located in the second floor.
Weapons or Firearms: Per licensee, there are no weapons or firearms. LPA did not observe any weapons or firearms.
Transportation: The licensee will not transport day care children.
The home was inspected inside and out for safety, comfort, cleanliness, and telephone service.

Documentation:
The required fire extinguisher (2A10BC) is located in the kitchen pantry. The LPA reminded the licensee in order for the fire extinguisher to meet State Fire Marshal standards the fire extinguisher must be serviced annually and have a service tag attached or a new one must be purchased annually. Smoke detectors are in operable condition. The home has a working Carbon Monoxide detector. There is a fireplace in the front room/children's playroom that is properly screened to prevent access to children. The licensee's Pediatric CPR/First Aid expire on 2/15/2023 . Preventative Health and Safety training that includes one hour of child nutrition was completed on 12/16/18. The licensee Michele Bernabe and her adult son Jonathan Bernabe had the required immunization against pertussis (TDAP), measles (MMR), and influenza. The required mandated reporter training (AB1207) was completed on 5/17/2021 by licensee. All adults in the home have a TB clearance.

The required posted documents were posted and located in the kitchen: Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC9148).

The following was discussed with the licensee:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and log the date and time;
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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: BERNABE FAMILY CHILD CARE
FACILITY NUMBER: 197700259
VISIT DATE: 06/19/2021
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Role and responsibilities of being a mandated reporter were reviewed; The licensee was reminded that 100% supervision is required at all times to children in care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

The licensee was informed that all adults living in or having access to the home, or are employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than #1 week. The licensee was advised to utilize the Request for Livescan Service LIC9163 to have adults fingerprinted and associated to the home. The licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified specified above. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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: BERNABE FAMILY CHILD CARE
FACILITY NUMBER: 197700259
VISIT DATE: 06/19/2021
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, licensees, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensees must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home; Installation of in-ground or above-ground swimming pools, spas, fish ponds, decorative water feature, fountains or other bodies of water; Construction of exterior decks or porches; Construction of play equipment including swing sets/climbing structures; Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm



The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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: BERNABE FAMILY CHILD CARE
FACILITY NUMBER: 197700259
VISIT DATE: 06/19/2021
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Prior to being licensed the following corrections are required Due by: 6/20/2021

· A/C unit shape blades needs to be made inaccessible

**As a result of this inspection, the home does not meet Title 22 Regulations. Corrections are required.

Exit interview was conducted and a copy of this report was read and discussed with licensee.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
LIC809 (FAS) - (06/04)
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