197700549-12-31-2021-12-CC-BTSA-CA8V4B-20211231150605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700549
Report Date: 12/31/2021
Date Signed: 12/31/2021 03:06:16 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:	YANEZ FAMILY CHILD CARE		FACILITY NUMBER:	197700549
ADMINISTRATOR:	MARISELA YANEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 878-4089
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 4	DATE:	12/31/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Marisela Yanez		TIME COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On December 31, 2021 at 10:21AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Applicant Marisela Yanez, who guided LPA on a tour of the facility for a Pre-Licensing - Change of Location inspection for a Large Family Child Care Home. This is a two story 4 bedroom, 2.5 bathroom home with kitchen/dining, day care room, living room, laundry room, upstairs office space, and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (Applicant and Applicant's Spouse) and four children. During inspection, Applicant's 4 biological children were present. Hours of operation are Monday Through Thursday, 6:30AM until 6:00PM and Friday, 6:30AM until 5:30PM. Incidental Medical Services (IMS) policy was discussed. Main care is provided in day care room (at entrance). Children use the half bathroom (Bathroom 1) on stairs directly to the right or the front entrance, across from the day care room. Bathroom is only available restroom on first level and is located on platform at the top of 3 steps at base of stairs. LPA will obtain manager consultation/approval regarding bathroom at top of 3 steps. Applicant provided declaration stating she will provide direct supervision to children under 5 years old in the day care room and provide direct assistance to children under 5 years old while using the restroom. Off limit areas include the entire upstairs (Bedrooms #1 through #4, bathroom #2 and #3, upstairs office space), laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room), medicines (top kitchen cabinet) and hazardous items (sharp knives in upper kitchen cabinet) that can pose a danger to children. Applicant reminded to conduct fire/earthquake drills every 6 months and document. A Roster was provided to Applicant to complete and maintain. Stairs have a gate.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

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: YANEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700549
	VISIT DATE: 12/31/2021

NARRATIVE

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The backyard is completely fenced. There is a playhouse, tricycles, and other age appropriate toys for the children to use. There is one dog that stays upstairs. Area is safe for children with not observable hazards. Applicant stated wiring on outdoor concrete slab is scheduled to be removed on 01/01/2022. Applicant agreed to send LPA pictures. During inspection, LPA observed Applicant's Spouse remove hose. Cleared during inspection.

Per Applicant, there are no weapons or firearms on the premises. LPA did not observe any in the home at this time. There are age appropriate toys. Age appropriate napping equipment (cots). The required fire extinguisher (2A10BC), smoke detector, and Carbon Monoxide Detector are in operable condition. Fireplace is screened. Home has central AC and heat. CPR/First Aid expire 02/01/2022. Preventive Health and Safety including Child Nutrition and Lead Poisoning Prevention Training completed 11/19/2021. Fire clearance completed 12/20/2021. The First Aid kit was observed and is complete with no-touch thermometer.

The following was discussed with the Applicant:
Applicant 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.
Applicant 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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

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: YANEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700549
	VISIT DATE: 12/31/2021

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Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed change, 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. 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 Policy (IMS) 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

During inspection, COVID-19 technical assistance was provided and COVID-19 protocols reviewed. The Child Care Program COVID-19 Self-Assessment is completed in the facility file.

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

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8:00AM - 5:00PM. LPA provided consultation during the inspection.

Before licensure the following must be completed:
1. LPM review/approval for bathroom at top of 3 steps at base of stairs.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

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: YANEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700549
	VISIT DATE: 12/31/2021

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Once corrections have been verified, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn. An exit interview was conducted, and a copy of this report was read and provided to the Applicant.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

LIC809 (FAS) - (06/04)

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