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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700430
Report Date: 07/10/2020
Date Signed: 07/27/2020 05:30:59 PM

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:ROSALES FAMILY CHILD CAREFACILITY NUMBER:
197700430
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
07/10/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Jimena RosalesTIME COMPLETED:
01:00 PM
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On 7/10/2020 Licensing Program Analyst (LPA) Isabel Ortega conducted a Tele-Visit with applicant Jimena Rosales, who guided the LPA on a tour of the facility for a pre-licensing Inspection. This inspection was held virtually due to COVID-19 Emergency Response and conducted via face time. Residing in the residence is the applicant only. This is a single home that consist of 3 bedrooms, 2 bathrooms, with kitchen, dining room, living room, family room(child care area) and attached garage.

LPA virtually inspected the facility in accordance to the facility sketch. Main care is conducted in the designated family room referred to as the Child Care area. Age appropriate toys and furniture were observed to be on the premises. All toys and furniture was observed to be in good condition during this inspection. There are cubbies in which the children can store belonging near the main door entrance. The children will use the restroom to the left next to the hallway. Mats were observed on the premises and will be utilize for napping. The part board is located to the left from the entrance of the home. The hours of operation are Monday thru Friday from 07:00 AM- 6:00 PM.



The home It is neat, clean, safe and sanitary. There is a fireplace in the home. It meets all safety requirements. The home has central air and heater. The fire extinguisher is at least a 2A10BC and is fully charged. The smoke alarms and carbon monoxide monitor are present and in good working conditions. The first aid kit is complete and available, and is store out of the reach of children. The off limits areas will be the 3 bedrooms, one bathroom, kitchen, dining room, living room, laundry room and the attached garage.

All chemicals and poisons are locked, and hazardous materials are kept inaccessible to children. Outdoor play area is free from defects or dangerous conditions, the outdoor play area is fenced went over active supervision and safety. Applicant agreed to level out the outdoor ground pavement as a preventative measure for preventing a tripping hazard.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: ROSALES FAMILY CHILD CARE
FACILITY NUMBER: 197700430
VISIT DATE: 07/10/2020
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Home is clean and orderly, age appropriate toys and play equipment, working smoke detector and carbon monoxide were tested at 11:21am and meet the fire marshal standards. LPA observed required fire extinguisher 210ABC that was a in operational condition. Electrical outlets were observed and covered. The home was clean and orderly. There is a Fire place in the home but it is barricaded with a sealed secured board inaccessible to children. According to applicant there are no fire arms or weapons in the home. LPA did not observe any weapons or firearms during the inspection.

Sharp items and 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 down the hallway, 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 towels and soap accessible for the children to use. There is a safety latch observed to be on the medicine cabinet door and on the lower kitchen sink cabinet. The laundry room was observed to be locked and is inaccessible to children.

The applicant's Pediatric CPR/First Aid expires on 11/05/2020. Preventative Health and Safety class that includes one hour of child nutrition was completed on 5/10/2020. Applicant presented Family Child Care Orientation certificate of attendance dated 5/12/2020. The applicant had the required immunization against pertussis (Tdap), measles (MMR), tuberculosis (TB) and influenza. The Mandated Reporter training was completed on 6/30/2020.



The following was discussed with applicant:
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 were reviewed; Applicant was 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 in the family child care home.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ROSALES FAMILY CHILD CARE
FACILITY NUMBER: 197700430
VISIT DATE: 07/10/2020
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The applicant was informed that all adults living in or having access to the home, or 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 one week. The applicant was advised to utilize the Request for Live Scan Service form LIC9163 to have adults fingerprinted and associated to the home.

The applicant 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 above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

The applicant 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 and licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and 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.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants 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.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ROSALES FAMILY CHILD CARE
FACILITY NUMBER: 197700430
VISIT DATE: 07/10/2020
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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 applicant 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

LPA discussed effective July 1, 2019 new immunization requirements and new immunization form provided. Also went over safe sleep upcoming regulation for infants 0 to 12 months old.

Child Care Advocates:
To sign up for our Quarterly Updates and Provider Information Notices (PINs), please subscribe online: http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe

The following was provided to the applicant: All licensing forms required in children's files; All licensing forms required in the facility; All licensing forms to be posted in the home; Fire and Disaster Drill log; California Car Seat Flyer; Safe Sleep Flyer; Parent Notification Requirements; and the 2020 Safe Sleep in Child Care brochure; and additional resources for the applicant and her Family Child Care Home.



Applicant’s Family Child Care Home License will be issued effective once the outdoor pavement has been leveled to prevent a tripping hazard. Applicant agreed within two weeks cement will be added, to level out the pavement preventing a tripping hazard. Applicant agreed to text/email a picture once outdoor payment has been fixed.

An exit interview was conducted, and a copy of this report will be via mailed to applicant for signature.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4