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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360918151
Report Date: 07/29/2021
Date Signed: 07/29/2021 12:12:29 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:MROSEK FAMILY DAY CAREFACILITY NUMBER:
360918151
ADMINISTRATOR:MROSEK, SUSANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 567-3816
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:14CENSUS: 10DATE:
07/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Susanna MrosekTIME COMPLETED:
12:24 PM
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Licensing Program Analyst (LPA) Aaron Mabika met with Susanna Mrosek licensee, who guided analyst on a tour of the facility for a random annual required inspection. During the time of this inspection licensee had ten children in care. Residing in the home includes the licensee and her spouse. Per LIS, facility annual fees are current. Licensee was operating facility within ratio during the time of inspection. Licensee was observed providing adequate supervision during the inspection. Upon initial arrival at the facility LPA observed children playing outside before coming in for snack at 10.00 AM. All children were actively involved in meaningful activities and all children were given a choice where snacks and activities to engage in.

This family child care facility is a single story home 4 bedrooms, 2 bathrooms with kitchen, living room, play room, outside patio, and attached garage. The attached garage was observed to be locked during the time of this inspection. The garage is used for storage only, the garage is off limits to children.


The kitchen was inspected and cleaning detergents and cleaning items were locked and made inaccessible to children. LPA observed that licensee keeps knives and other sharp objects on top of the refrigerator. Knives, sharp objects, and hazardous items were observed to be inaccessible to children during the inspection. There is a laundry room located in the play room that was observed to be locked by magnetic key. All detergents and cleaning items were stored in the laundry room and in a cabinet under the sink secured by magnetic locking devices and inaccessible to children.
Main care is conducted in the living room, back yard, outside patio, play room.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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: MROSEK FAMILY DAY CARE
FACILITY NUMBER: 360918151
VISIT DATE: 07/29/2021
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Children have access to bedroom 2 which LPA observed that there were puzzles and games. Licensee states that bedroom # 3 is used for napping only. LPA observed the children had lots of space for activities while distanced. The family has 2 pet dogs which are kept in pens and made inaccessible to children. Licensee states the pets are all current in terms of vaccinations.

LPA observed a first aid supplies box on premises at this facility. Areas off limit include: bedroom #1 near living room on right side, bedroom #4 bedroom, garage, and laundry room.


Children have access to the back yard area, the back yard is dirt landscaping and no dangerous rocks were observed. There were several age-appropriate swing sets observed out side that were properly anchored to the ground. There was cushioning underneath the swing sets/ play apparatus to absorb a fall of a child. LPA observed a tree and canopy for shade. The back yard is completely fenced in.
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 finger print cleared prior to being in the home. Individuals within one month of their 18th birthday must be fingerprinted immediately or at least within 30 days or less of turning 18.
There shall be no smoking, no infant walkers, johnny jumpers, exersaucers and any other item that falls into that category. Also discussed were earthquake, fire & disaster drills shall be documented at least once every six months . Posting requirements were discussed such as the posting of the Parent’s Rights poster in a visible location for the children’s authorized representatives.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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: MROSEK FAMILY DAY CARE
FACILITY NUMBER: 360918151
VISIT DATE: 07/29/2021
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Children records requirements, mandated child abuse and injury/ death reporting, background check clearance transfer requirements, SIDS, Infants Safe Sleep on Back, and Never Shake A Baby were all discussed. Licensee agrees children shall be positioned for sleep on their back. Covid protocols were discussed with licensee.
There is a bathroom located in the hallway in adjacent to the living room which the children utilized. The bathroom was inspected. LPA observed that the bathroom was free, and clear of debris or hazardous substances. The bathroom was in sanitary condition. The cabinet underneath the sink had child proof magnetic locks. LPA observed tissue paper, and towels in the cabinet. There were ample towels and soap available for the children. LPA observed there was a variety of age appropriate toys in the home. There was a fire placed observed in the living room area, The fireplace was gated by a screen barricade and is inaccessible to children and Licensee states it is only used in winter.

Per licensee, there are no firearms or weapons on premise. There were no pools or bodies of water observed to be on the premises.

LPA reviewed 4 children records, records were complete. Licensee and spouse have CPR/First Aid due for renewal on 13 October 2022. LPA observed that licensee had submitted record of immunization. LPA observed that the licensee and her spouse had current Mandated reporter training. .

Parent board was observed to be in the in the play room. All required licensing document were posted. All electrical outlets were properly covered. The home is clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and carbon monoxide. The fire extinguisher 2A10BC was observed to be operational during today's inspection. The home has a working telephone service available. Per licensee, disaster/fire drills are conducted every 3 months. LPA observed disaster/fire drill log it was current with last date being April 30/2021)

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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: MROSEK FAMILY DAY CARE
FACILITY NUMBER: 360918151
VISIT DATE: 07/29/2021
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This facility has napping equipment in which the children can sleep on.

Licensee completed Mandated Reporter Training AD 1207 a copy of the certificate was obtained for records.

**Licensee informed to review updates/regulations for 2016/2017 on the department website: www.ccld.ca.gov ; AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles, and TB clearance, beginning September 1, 2016; AB 2231 Effective July 1, 2017 - Civil Penalty Amount changnotes.

This facility was not cited today pertaining to the California Code Title 22 Regulations.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4