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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360919005
Report Date: 10/11/2022
Date Signed: 10/11/2022 12:29:49 PM


Document Has Been Signed on 10/11/2022 12:29 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:ULIBARRI FAMILY DAY CAREFACILITY NUMBER:
360919005
ADMINISTRATOR:ULIBARRI, NILDA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 252-4425
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:14CENSUS: 0DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:ULIBARRI NILDATIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA), Babatunde Ibitoye met with licensee, Nilda Ulibarri today for the purpose of conducting Required 1 year unannounced Annual inspection. Present today were licensee, and 0 day care children. The home is a single story family home with 3 bedrooms (1 bedroom is used as an office and off limits to children) and 2 bathrooms (children use 1 bathroom only). **There are no pools, spas or any other bodies of water on the premises. All adults in the home, licensee and husband. Both have been fingerprint clearances and exams for T.B. The living room; family room; backyard; and the front bathroom are designated for child care. Dining area; living room; 1 bathroom and backyard. Office is off limits. The days and hours of operation are Monday -Thursday (6am to 4:30pm). And close every other Fridays

Fireplace is screened and home has central heating and air conditioning. The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children. The outside play area was clear of chemicals and debris, the entire yard is fenced. All unused electrical outlets are plugged and play equipment and toys are available. Licensee is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. Licensee CPR and First Aid training (exp 07/15/2021) see LIC 809D .Licensee provided a copy of her Mandated Reporters training (AB1207) .
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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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Document Has Been Signed on 10/11/2022 12:29 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: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2023
Plan of Correction
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Licensee will submit proof by due date
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: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005
VISIT DATE: 10/11/2022
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LPA reviewed 2 children record and 1 Staff file, LPA reviewed the childcare facility roster and the fire drills, earthquake drills log and documentation for both. Incidental Medical Services (IMS) were discussed. Per licensee, the facility is not currently providing IMS. LPA informed licensee to refer to IMS information in the 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 information was discussed with the licensee:

· Mandatory Forms for the children’s files and provider’s files.

· Requirements for fire drills, earthquake drills and documentation for both. The last fire/earthquake drill was completed 03/15/2022, LPA advised licensee to conduct a disaster drill every six months.

· Role and responsibilities of being a mandated reporter was discussed.

· Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

· The licensing department must have the facility’s phone number. If the phone number is changed, the licensing department must be notified.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005
VISIT DATE: 10/11/2022
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.

· On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatedreporterca.com

· AB 290 - for each new license issued, at least one director or teacher at a childcare center or family child- care home shall have at least one hour of childhood nutrition training. · Senate Bill AB 2231 Civil Penalty Amount Changes. Changes Effective 7/1/2017.

· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit. **In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.

· The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

· Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty

· Licensee is made aware that Title 22 Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child- care home, and in those areas of the family day care home where children are present.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005
VISIT DATE: 10/11/2022
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**§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements

· Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.

· State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

. Safe Sleep: 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.

· Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

· Licensee advised visit www.shotsforschool.org for Immunization information.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005
VISIT DATE: 10/11/2022
NARRATIVE
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Deficiency Cited : See 809D

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 the licensee ULIBARRI NILDA.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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