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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360919005
Report Date: 09/26/2019
Date Signed: 09/26/2019 12:27:22 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:ULIBARRI FAMILY DAY CAREFACILITY NUMBER:
360919005
ADMINISTRATOR:ULIBARRI, NILDA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
7602524425
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:14CENSUS: 7DATE:
09/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Nilda UribarriTIME COMPLETED:
12:32 PM
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Licensing Program Analyst (LPA), Montoya met with licensee, Nilda Ulibarri today for the purpose of conducting and unannounced Annual/Random inspection. Present today were licensee, spouse and granddaughter and 7 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.

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 has current CPR and First Aid training (exp 07/15/2021) Licensee provided a copy of her Mandated Reporters training (AB1207) She agree to provide LPA with Certificate of Completion by Friday 9-27-2019.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005
VISIT DATE: 09/26/2019
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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.

**Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation. **Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty. In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report documenting the Type A citation and sign form LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to. Staff is aware of required forms for children's files and forms that shall be posted after licensure.

Copy of 811 (Confidential Names List) was provided during this inspection. Exit Interview conducted a copy of this report is discussed and left at the facility.

There were no violations noted as result of this inspection.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ULIBARRI FAMILY DAY CARE
FACILITY NUMBER: 360919005
VISIT DATE: 09/26/2019
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Per licensee, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devise are in operable condition. Current Roster and Record of Disaster drills verified.

· Licensee can access forms on line at www.ccld.ca.gov . LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility. LPA informed licensee of the Departments Child Care Advocate’s (CCA’s) that can forward Quarterly Updates regarding Child Care Licensing’s’ Rules and Regulations. You may contact the Child Care Advocate Program directly at (714) 308-1612 Jane Cong-Huyen or email her at: Jane.Cong-Huyen@dss.ca.gov

The licensee is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

Licensee is urged visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled

Licensee is reminded of the following:


- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
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