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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700386
Report Date: 01/18/2023
Date Signed: 01/18/2023 05:00:14 PM


Document Has Been Signed on 01/18/2023 05:00 PM - 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:COLLINS FAMILY CHILD CAREFACILITY NUMBER:
197700386
ADMINISTRATOR:COLLINS JOCELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
6613000163
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 4DATE:
01/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jocelyn CollinsTIME COMPLETED:
04:00 PM
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On 01/18/2023, at 9:45 a.m., Licensing Program Analysts (LPAs) Joselito L. Del Mundo conducted an unannounced annual inspection at the Collins Family Child Care Home to assess the Facility operation of their program, its current physical plant status and its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. LPAs Del Mundo and Dorsey met with Licensee, Jocelyn Collins and stated the reason for the inspection. The LPAs provided a copy of the Entrance checklist form, LIC 126.

Licensee states the day care hours of operation is 6:00 AM to 6:00 PM Monday thru Friday. Currently living in the home is licensee and licensee's 6 children (triplets – 5 year old, 1 son – 6 year old, 2 daughters (7, and 17).

LPA Del Mundo told Licensee that to better assure and promote the health and safety of each individual being cared for in licensed setting, the Community Care Licensing Division's (CCLD) developed the Compliance and Regulatory Enforcement (CARE) Tools for the Child Care Program which is being used during today's inspection. At 10:00 a.m., LPA Del Mundo along with the Licensee conducted a walk through of the entire family child care facility.

The Facility license is posted on a prominent place of the facility. The home is licensed to provide day care services to 12 children. All of the play yards or playpens used by the facility are made of material (mesh or fabric) that has not been banned or recalled by the United States Consumer Product Safety Commission. The home is clean, safe and orderly, with heating and ventilation for safety and comfort. The home maintain telephone service (Licensee was advised the cell phone shall be charged and available during day care hours.) The facility has safe age appropriate toys, play equipment and materials for the children care to use. At the time of this inspection, there are no fixtures, furniture, and/or equipment that have been banned or recalled by the United States Consumer Product Safety Commission. Areas where care is being provided are dining room and living room. Backyard is considered as an outdoor play area. Bathroom # 1 and kitchen are accessible to children Per Licensee,
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700386
VISIT DATE: 01/18/2023
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if food is brought from the children's homes, the container is labeled with the child's name and properly stored or refrigerated.

The facility is not free from defects or conditions which might endanger a child. Licensee has a schedule repair/installation of waterproof baseboards on the floor on 01/21/23. There is no fireplace in the facility. The facility has an operational carbon monoxide detector and fire extinguisher which meet established standards. The facility is a one story house. Poisons, detergents and cleaning compounds are stored in the upper cabinets where they are locked and inaccessible to children. First aid kit is located above the refrigerator. There are no firearms (no firearms at this facility) and other items which could pose a danger if readily available to children. The facility has a written disaster plan of action prepared. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted once a month, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility.

Smoking is prohibited on the premises of a family child care home. Currently, there are no infants in their program. However, Licensee is aware of new regulatory requirements regarding the safe sleep regulatory requirements. She knows that there must be one crib or play yard for each infant who is unable to climb out of the crib or play yard. The crib(s) or play yards use by the facility must meet the United States Consumer Product Safety Commission safety standards. Placement of crib(s or play yards shall not hinder entrance or exit to/and from the space where infants sleep. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. The mattresses shall be made specifically for the size crib or play yard in which they are placed.

The LPA explained Licensee how to obtain information from the Community Care Licensing (CCL) Web Applications (www.ccld.ca.gov) and provided advise on how to obtain Providers Information Notices (PINS) and CCL Quarterly Updates; Child Abuse Mandated Reporter Training (www.mandatedreporca.com); Lead Safety Information; Personnel/Assistant Requirements; Safe Sleep; Incidental Medical Services (IMS) Reporting Requirements; Guardian program, and other CCL requirements. The Facility does not have any
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
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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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700386
VISIT DATE: 01/18/2023
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bodies of water. The outdoor play area (backyard) needs to be clean.
Per Licensee, she is present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences does not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she shall be isolated from other children, and the nature of the illness is determined. If it is a communicable disease he/she shall be separated from other children until the infectious stage is over.

The licensee has completed or renewed their mandated reporter training and is current with required immunization or exemptions from immunization. At the time of inspections, licensee could not provide training on preventive health practices, however, pediatric cardiopulmonary resuscitation and pediatric first aid certificates are provided. Records Licensee and assistant have been immunized against influenza, pertussis, and measles. Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or within 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report unusual incident/injuries report can also be mailed to unusualIncidentreport@dss.ca.gov

Licensee is aware that personnel records of the Licensee and each assistant (if any) shall be maintain which contain the following information:
Licensee and staff full name; A signed and dated copy of the Notice of Employee Rights [LIC 9052,]; A signed statement regarding their criminal record history, LIC 508; Driver's license number if the employee is to transport children; Date of employment; Date of birth; Current home address and phone number; Documentation of completion of training on preventative health practices as required by Section 102416(c). All personnel records are maintained at the facility. Any change to the facility from an area of the family child care home should be reported to the Department. Licensee and assistant(s) have been immunized against influenza, pertussis, measles and a copy of TB clearance/risk assessment was also kept on file. Licensee and other adults living in the home or working at the facility have received criminal record clearance and association. There is an emergency information card maintained for each child in care, completed and up to date. The Licensee and other persons associated to the facility have obtained appropriate clearance or a criminal record exemption as required by the Department.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
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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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700386
VISIT DATE: 01/18/2023
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 Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

LPA encouraged licensee to become familiar with the CARE Tools and inspection processes by periodically visiting the Inspection Process Project and CARE Tools Website. The page will be updated regularly with information related to the new tools and related documents:
https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Regarding COVID-19, the LPA advised the Licensee that they should continue to follow COVID-19 requirements and guidance in all applicable CDSS Providers Information Notices (PINs) and All County Information Notices (ACINs), in addition to guidance or instructions from health care providers, Centers for Disease Control and Prevention (CDC), CDPH, Department of Developmental Services (DDS), Cal/OSHA, and local public health departments, as applicable to the particular facility or home category. If there are differing requirements between the most current CDC, CDPH, CDSS, DDS, Cal/OSHA, and local health department guidance or health orders, licensees and providers should follow the strictest requirements.

Overall, the Facility is not in compliance per Title 22 regulations. During today's inspection the LPAs observed deficiencies that may hinder the health and safety of the children in care. Deficiencies were cited during this inspection. An exit Interview was conducted and a discussion of observations and this report was conducted. View points were discussed. Also, the LPAs provided additional information: how to locate Provider Information Notices (PINs) Quarterly Updates; where to locate Child Care Training; and where to access the new background check system, Guardian. Per Licensee request, LPAs provided assistance and guidance regarding Title 22 requirements.

A copy of this Report, Review of Staff Records form (LIC 859), Appeal Rights and Notice of Site Visit (LIC 9213) were provided to Licensee, Jocelyn Collins.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/18/2023 05:00 PM - It Cannot Be Edited

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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700386

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department All children age and ability permitting, and the provider, assistant provider and other members of the household shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above and found out that portions of the flooring in the day care area does not have any baseboards installed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2023
Plan of Correction
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Waterproof baseboards will be installed on the floor on 01/21/23 and LPA will be provided copies of the corrected areas.
Type B
Section Cited
CCR
102416.1(a)(6)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/18/2023 05:00 PM - It Cannot Be Edited

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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700386

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(6)
(a) Personnel records shall be maintained on each employee and shall contain the following information:
(6) Documentation of completion of training on preventive health services as required by section 102416(c)

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above iand found out that Licensee has no certificate on preventive health praactices which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2023
Plan of Correction
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Licensee shall provide a copy of the traninng certificate to LPA on or before 02/17/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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