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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700420
Report Date: 06/18/2020
Date Signed: 06/19/2020 10:31:23 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:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197700420
ADMINISTRATOR:THERESA DE JESUS VAZQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 218-7295
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 0DATE:
06/18/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Theresa De Jesus Vazquez TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Victoria Hunt conducted a Tele-Visit with Applicant Theresa De Jesus Vazquez, who guided analyst on a tour of the facility for a pre-licensing Inspection for a relocation. This visit was held virtually due to COVID-19 Emergency Response. Residing in the residence is the applicant, her spouse and minor children. This home consists of 5 bedrooms, 2 1/2 bathrooms, with kitchen/dining, family/living room, and a attached garage. LPA inspected the facility in accordance to the facility sketch. Main care is conducted in the designated rooms (living room, dining room and all bedrooms downstairs). Age appropriate toys and furniture were observed to be on the premises of this facility. There is a two bedrooms downstairs one is an infant room that has four cribs and the other is the playroom. There is a small fish tank in the living room with a cover and cubbies were observed that store toys.

Physical Plant: Home is clean and orderly, age appropriate toys and play equipment, working smoke detector and carbon monoxide. LPA observed required fire extinguisher located in the laundry room. There is a security gate located on the staircase to prevent children from accessing the upstairs bedrooms. The security gate was observed to be in good condition.

Kitchen: The kitchen is inaccessible there are two security gates on both sides of the kitchen that prevent children from accessing the area. Sharp items, objects and cleaning items are locked. Cleaning items are stored in the lower cabinets which are secured by child proof latches. Children utilize a bathroom in the hallway by the main door. The bathroom was observed to be free and clear of hazardous items. The bathroom was observed to have working toilet, sink, and an ample supply of paper towels and soap accessible for the children to use. The cabinets were observed to be empty and there were child proof latches on the cabinet doors.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2020
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: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700420
VISIT DATE: 06/18/2020
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This facility has a first aid kit on premises. LPA observed that licensee and her assistant have a valid Pediatric CPR and First Aid card that expires on 01/21. A copy of the of the Pediatric CPR and First Aid was obtained for the file. Applicant has completed mandated reporter training and has the required immunization for pertussis, measles and influenza.

Per licensee there are no weapons or firearms on the premise. There are no pools or bodies of water on the premises. Child have access to the backyard there is a canopy for shade and a large wooden play structure with the side that is anchored to the ground. There is another small play structure on the backyard along with other small toys that the children can play with.

Areas off limit include: all bedrooms upstairs, laundry room and garage.

Licensee is not providing any medical services to children. 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: Individuals who are 18 years of age or older living in the home must be fingerprint cleared prior to being in the home. Individuals within one month of their 17th birthday must be fingerprinted immediately or at least within 30 days or less of turning 18.

Licensee advised of capacity requirements for a large family childcare. Licensee informed that facility

Fire clearance sent was approved on 05/28/20 for a large capacity. This facility is approved for licensure effective 06/18/20.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2020
LIC809 (FAS) - (06/04)
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