<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805330
Report Date: 10/11/2023
Date Signed: 10/11/2023 05:04:49 PM


Document Has Been Signed on 10/11/2023 05:04 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:YOUNG FAMILY CHILD CAREFACILITY NUMBER:
364805330
ADMINISTRATOR:YOUNG, SHERESEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 243-1880
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 2DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Sherese Young, LicenseeTIME COMPLETED:
05:15 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 October 11, 2023, Licensing Program Analyst (LPA) Calloway met with Licensee, who granted access. LPA and Licensee toured the home for an Annual Random inspection. Family members residing in the home include 3 adults (licensee, spouse, daughter). The home is licensed for fourteen (14) children. LPA observed two kids in care that were Licensee’s 6 yr. old grandchildren. Incidental Medical Services (IMS) policy was discussed.
Physical Plant: This is a single story 5-bedroom, 2-bathroom home with kitchen, dining, family room, living room, and garage (locked). Childcare is provided in Bedroom #5 (end of hallway). Children’s Bathroom is in hallway (right side) (observed with hazards). Unused outlets (covered). Age-appropriate furniture, toys, and books. Napping (mats) equipment. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink-safety lock), medicines (Per Licensee none). Kitchen- hazardous items that can pose a danger to children (Sharp knives pantry up high). Fire/earthquake drills complete (current). Roster (current). The required fire extinguisher (2A10BC) (full/green). Smoke detectors and carbon monoxide detectors (operable). Fireplace is screened. LPA recommended safety latch. Home has central AC and heat. Required postings were not all present on the wall. There are two surveillance cameras inside the day care area that are operable. Storage closet that has a digital key lock and small locked cabinet.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


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: YOUNG FAMILY CHILD CARE
FACILITY NUMBER: 364805330
VISIT DATE: 10/11/2023
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
Off limit areas: include Bedrooms (#1, #2, #3 #4), Bathroom #2, laundry area (locked) garage (key lock).
Outside: The backyard is completely fenced. One (1) dog (vaccinated). Per Licensee, dog remains outside and does not interact with the day care children. No pool/spa or body of water on the premises. Per Licensee, back yard is off limits and there is a written declaration. LPA requested updated declaration for back yard.
Others: Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any in the home. Required training & CPR/First Aid (expires:12/15/23). First Aid kit observed (complete). LPA viewed staff and children’s files and conducted a staff interview with the Licensee. Transportation not provided. Proof of immunizations for Licensee and spouse needed. Spouse needs Mandated Reporter training. There was a waiver granted for baby walker that is no longer needed Licensee’s daughter is an adult. The home has daycare liability insurance.
The following was discussed with the Licensee:
Maintain capacity requirements, Notification of Parent's Rights (updated with correct information), Roster requirements (keep updated names), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, updated Safe Sleep regulations were discussed and provided. The role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is always required to children in care. If food is brought in, it is properly labeled. Licensee will check food expiration dates periodically. Licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: YOUNG FAMILY CHILD CARE
FACILITY NUMBER: 364805330
VISIT DATE: 10/11/2023
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
Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. 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). Type A citation: Type A citation(s) shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee is advised visit www.shotsforschool.org for Immunization information.

--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640


--Family Child Care Providers (Disaster Planning information):https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Child Care Videos: https://ccld.childcarevideos.org
-
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: YOUNG FAMILY CHILD CARE
FACILITY NUMBER: 364805330
VISIT DATE: 10/11/2023
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
-Licensee advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
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 On Duty Worker is available for questions at (661) 202-3318 Monday-Friday 8am-5pm for information and reporting Unusual Incident reports: @ unusualincidentreport@dss.ca.gov.

LPA discussed (Safe Sleep) during the inspection.

Per Title 22 Regulations, there are deficiencies cited during the inspection. See 809 D pages.

An exit interview was conducted, a copy of this report was read and a Notice of Site Visit, and Appeal Rights, were provided to Sherese Young, Licensee. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain the posting may result in $100 civil penalty.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 10/11/2023 05:04 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: YOUNG FAMILY CHILD CARE
FACILITY NUMBER: 364805330

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, the licensee did not comply with the section cited above in LPA observed mouthwash on the counter and shampoos and soaps inside the shower in children's bathroom which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/12/2023
Plan of Correction
1
2
3
4
Licensee will remove any poisons that can cause hazard to the children and provide a written declaration that this will be done by POC date of 10/12/23.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 10/11/2023 05:04 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: YOUNG FAMILY CHILD CARE
FACILITY NUMBER: 364805330

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview,record review, the licensee did not comply with the section cited above in S2 does not have current mandate reporter training on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2023
Plan of Correction
1
2
3
4
Licensee will check for a class available and provide proof to Licensing by POC date of 10/20/23.
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
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in S1 and S2 (spouse) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2023
Plan of Correction
1
2
3
4
Licensee and Spouse did not have current immunizations against MMR, TdaP and Influenza and provide proof to Licensing by POC date of 10/20/23
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) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 10/11/2023 05:04 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: YOUNG FAMILY CHILD CARE
FACILITY NUMBER: 364805330

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in children did not have in their files the LIC 995A form signed by parents for C1, C2, C3, C4, and C6. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2023
Plan of Correction
1
2
3
4
Licensee will provide proof of LIC 995A to Licensing by POC date of 10/20/23.

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) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7