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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700392
Report Date: 06/17/2022
Date Signed: 06/17/2022 04:46:04 PM


Document Has Been Signed on 06/17/2022 04:46 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:DIAZ-BANOS FAMILY CHILD CAREFACILITY NUMBER:
197700392
ADMINISTRATOR:BLANCA DIAZ-BANOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 418-6088
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:14CENSUS: 8DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:Blanca Diaz-BanosTIME COMPLETED:
05:00 PM
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On June 17, 2022 at 12:29PM, Licensing Program Analysts (LPAs) Brigitte Tsutaoka and Barbara Beneroso met with Licensee, Blanca Diaz-Banos, who guided analysts on a tour of the facility for an Annual Random inspection. This is a two story 4 bedroom, 3 bathroom home with kitchen/dining, living room, family room, and garage. There is no pool/spa or body of water on the premises. Hours of operation are Monday through Saturday, 6:00AM to 6:00PM. Upon arrival, LPAs observed 8 children in care with 2 staff, one staff not on association list. Licensee disclosed Staff 1 has worked at the facility since Monday, 6/13/2022 and has been present each day (for total of 5 days). California Code of Regulations Title 22 Division 12 Chapter 1 102370(d) Criminal Record Clearance Type A deficiency was cited during inspection and a $500 civil penalty assessed. During inspection, LPA observed Staff 1 leave the facility. Family members residing in the home include 1 adult (licensee) and two minor children. Licensee disclosed one child will be turning 18 during 2022. LPA provided consultation to obtain criminal record clearance once her child turns 18. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in family room and living room. Children use the bathroom in hallway. Off limits areas include entire upstairs (Bedrooms #2 through #4, bathrooms 2 and 3), bedroom 1, kitchen, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink), medicines (in top kitchen cabinet) and hazardous items (sharp knives upper kitchen cabinet) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. There is AC and heat.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
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: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392
VISIT DATE: 06/17/2022
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Home is clean and orderly, fireplace is screened/inaccessible, age appropriate toys and play equipment are available. LPAs observed working smoke detector and carbon monoxide, tested during inspection. LPA observed required fire extinguisher (2A10BC) serviced 6/03/2022. No one smokes in the home, no prohibited items in the home. There is a designated area for ill child(ren) in the family room. Per Licensee, no weapon/firearms on the premises. LPAs did not observe any at this time. Working telephone verified (cell). Poisons, medication and cleaning items inaccessible to children. Window cords inaccessible.

Safe and age appropriate toys, play equipment and materials are accessible. 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 are age appropriate napping equipment (cots and crib).

Bathroom: Shower free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. LPAs observed hand washing flyer in restroom. Toilet and faucet are clean and operable.

(Off-Limits) Kitchen: The following are inaccessible: Sharp items, plastic bags, cleaning items, no chemicals in the kitchen were observed accessible. Entrances to kitchen have child safety gate, making kitchen inaccessible to children in care. There is a fully stocked refrigerator/freezer. Breakfast, lunch and snack are served. Food brought from the children’s home is labelled and dated.

Outdoor: Backyard is fenced all around with age appropriate toys in good repair available for children. There are tricycles and two plastic activity structures accessible to children. The play area is completely gated.

First Aid kit was observed with thermometer readily available. Licensee has CPR/First Aid 01/08/2024 and Mandated Reporter 04/24/2024. Licensee does no have liability insurance. Child/staff files reviewed. LPAs observed the Parent Notification Additional Children in Care (LIC9150), Consent for Medical Treatment (LIC627), and Affidavit Regarding Liability Insurance (LIC282) missing in child files. California Code of Regulations Title 22 Division 12 Chapter 1 102417 Operation of a Family Child Care Home Type B violations were cited during inspection. Required documents posted.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
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: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392
VISIT DATE: 06/17/2022
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Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: unusualincidentreport@dss.ca.gov). 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 above.

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 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 record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed, to be completed every two years; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is her responsibility to know the regulations as well as anyone who assists in providing 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. Per Licensee no on smokes in the home. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392
VISIT DATE: 06/17/2022
NARRATIVE
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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.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Type A and Type B violations cited during inspection and a $500 civil penalty for Criminal Record Clearance was assessed. See LIC809D for deficiency details.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392
VISIT DATE: 06/17/2022
NARRATIVE
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LPAs informed licensee Blanca Diaz-Banos that this report dated 6/17/2022 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPAs informed the licensee to provide a copy of this licensing report dated 06/17/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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 Licensee Blanca Diaz-Banos.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 06/17/2022 04:46 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by permitting staff to work at the facility who had not completed a criminal record clearance pursuant to Health and Safety Code 1596.871 prior to working at the facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2022
Plan of Correction
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Staff 1 left the premises during inspection. Licensee agreed to submit plan to the Department detailing how to ensure all staff present at the facility are criminal record cleared prior to their first day of work at the facility.
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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
LIC809 (FAS) - (06/04)
Page: 6 of 8


Document Has Been Signed on 06/17/2022 04:46 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by failing to obtain completed Consent for Medical Treatment (LIC627) and maintain copies in the child files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2022
Plan of Correction
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Licensee agreed to obtain completed Consent for Medical Treatment (LIC627), maintain copies in the child files, and submit copies to the Department no later than 07/08/2022.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by failing to obtain the complete Affidavit Regarding Liability Insurance (LIC282) and maintain copies in the child files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2022
Plan of Correction
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Licensee agreed to obtain completed Affidavit Regarding Liability Insurance (LIC282) for all children enrolled, maintain copies in the child files, and provide copies to the Department no later than 07/08/2022.

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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
LIC809 (FAS) - (06/04)
Page: 7 of 8


Document Has Been Signed on 06/17/2022 04:46 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: DIAZ-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197700392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)1
(d) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child as required in Section 102416.5(h).
(1) The licensee shall maintain a completed and signed LIC 9150 (Rev. 8/14) Parental Notification Additional Children in Care, which is incorporated by reference, for this purpose.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by failing to obtain completed Parent Notification Additional Children in Care (LIC9150) and place in child files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2022
Plan of Correction
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Licensee agreed to obtain completed Parent Notication Additional Children in Care (LIC9150) for all children in care, maintain copies at the facility, and provide copies to the Department no later than 07/08/2022.
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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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