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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804106
Report Date: 10/25/2022
Date Signed: 10/25/2022 02:06:42 PM


Document Has Been Signed on 10/25/2022 02:06 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:HALL FAMILY CHILD CARE HOMEFACILITY NUMBER:
364804106
ADMINISTRATOR:PAULA HALLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 401-7018
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:14CENSUS: 7DATE:
10/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Licensee Paula Hall TIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee, Paula Hall who guided analyst on a tour of the facility for the One Year Required inspection. This is a single story house with two bedrooms, three bathrooms, kitchen/dining room, living room, daycare room, utility room and backyard. Per Licensee the day care room, bedroom 2, bathroom 2 (located outside of bedroom 2), bathroom 3 (located in day care room), living room, dining room kitchen and the backyard utilized for the family child care activities. Per licensee off-limit areas of the home are the master bedroom, master bathroom, utility room and laundry room. The off limit areas of the home were inaccessible via locked doors. Upon arrival, LPA observed one infant and six preschool age children in care with the Licensee and staff 1 (S1) providing supervision. Currently living in the home is the Licensee, and adult 1. All adults are associated and have eligible clearances. Current days and hours of operation are Monday thru Friday 6:00am -5:30pm.
Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. According to Licensee all cleaning products are stored in the locked utility room and in a cabinet under the kitchen sink. The cabinet was equipped with a magnetic safety lock. Sharp knives were stored in a high cabinet that was inaccessible to the children in care. Licensee and LPA discussed that the family child care license allows the Licensee to care for children until 12 years of age. Therefore the Licensee had to continually assess the environment to ensure items are inaccessible to children from 0-12. Household medications were stored in high hallway cabinet. Per recorded documentation Fire/earthquake drills are completed monthly. The last drill was completed in September 2022. The fire extinguisher was serviced in November 2021.
Safe and age appropriate toys, play equipment and materials were present inside the home. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes inside the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The day care room is the designated area for ill children in the child care. Report continued on page two
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
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 10/25/2022 02:06 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: HALL FAMILY CHILD CARE HOME
FACILITY NUMBER: 364804106

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in one of two staff file. S1 has not been immunized against influenza, pertussis, and measles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2022
Plan of Correction
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Per Licensee, staff will obtain the required immuizations. A copy of the proof of the immunizations will be sent to the Department.
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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HALL FAMILY CHILD CARE HOME
FACILITY NUMBER: 364804106
VISIT DATE: 10/25/2022
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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home has a fire place. The home has central heating and air conditioning along with a mini split.
Bathrooms: Toilet, sink, faucet were clean and operable.
Outdoor: The outdoor space consists of on limit and off limit areas. The designated outdoor play area is located off the day care room. The outdoor play space was enclosed by a chain link fence. The off limit area was inaccessible via a locked gate. LPA observed dramatic play houses, multiple little tikes climbing structures, a tether ball along with additional age appropriate materials. LPA advised the Licensee to ensure all outdoor climbing equipment meets the manufactures requirements regarding the fall zone surrounding the climbing equipment.

Per Licensee, there is one dog in the home. Per Licensee, the dog interacts with the child care children. Per Licensee the dog is current on shots.

CPR/First Aid expires 1.30.23 and mandated reporter training expires 7.9.24.


Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA reviewed nine child files, files were complete and contained all required information. One of the files was for an infant under 12 months of age. LPA observed the Infant Safe Sleep Plan and the 15 minutes checks. LPA also reviewed the Licensees and S1 file. Based on LPA record review and conversation with the Licensee and Staff 1. Staff 1 has been employed since approximately June 2021. S1 has not been immunized against pertussis and measles. A type B citation was used for regulation 1597.622(a)(1) as it is required for employees to have the immunization's. LPA advised the Licensee to utilize the LIC 311D and LIC 126 to ensure all staff/household member files contain all required documentation.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings. .
The following were observed: Notification of Parents' Rights (PUB394), License, Emergency and Disaster Information (LIC610A).

Report continued on page three

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HALL FAMILY CHILD CARE HOME
FACILITY NUMBER: 364804106
VISIT DATE: 10/25/2022
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Report continued from page two
The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/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.



The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

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.

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.

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


LPA and Licensee discussed Unusual Incident Reports and the need to report within the required time frames. Report continued on page three
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HALL FAMILY CHILD CARE HOME
FACILITY NUMBER: 364804106
VISIT DATE: 10/25/2022
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Based on LPAs record review there was one type B citation issued today regarding staff records. in addition one technical advisory notice was issued.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Paula Hall.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6