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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808486
Report Date: 11/30/2022
Date Signed: 11/30/2022 12:17:20 PM


Document Has Been Signed on 11/30/2022 12:17 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:FOWLIE-PETERS FAMILY CHILD CAREFACILITY NUMBER:
364808486
ADMINISTRATOR:FOWLIE-PETERS, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 951-5770
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:14CENSUS: 5DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Linda Fowlie- PetersTIME COMPLETED:
12:45 PM
NARRATIVE
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On 11/30/2022 Licensing Program Analysts (LPAs) Beneroso and Villa met with licensee, Linda Fowlie-Peters who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival, LPAs observed 5 children in care and 1 adult caring for them. Family members residing in the home include just the licensee. The facility operates 24hrs and licensee is aware of regulations pertaining to 24-hour care. Licensee currently does not have childcare insurance.

This family child care facility is a single story 3 bedrooms, 2 bathrooms with kitchen, living room, dining room, playroom, and attached garage. The garage was observed to be locked, it has a security latch on top of the door and a key bolt. The garage is used for storage only, the garage is off limits to children. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPAs observed age appropriate safe toys and napping equipment on the premises. Naps are provided on mats the living room (childcare area)


There are no pools or bodies of water in the facility.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
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 11/30/2022 12:17 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: FOWLIE-PETERS FAMILY CHILD CARE
FACILITY NUMBER: 364808486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

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
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Based on record review, the licensee did not comply with the section cited above. Children do not have LIC 700 and individual sleeping plan which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2022
Plan of Correction
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Licensee will submit proof of forms signed by parents via email or text with pictures.

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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
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: FOWLIE-PETERS FAMILY CHILD CARE
FACILITY NUMBER: 364808486
VISIT DATE: 11/30/2022
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LPAs observed detergent and cleaning compounds to be kept in the kitchen, in the cabinet under the sink which is locked with a safety latch. Medicines were observed to be kept in the kitchen in an upper cabinet. Sharp kitchen knives were also observed to be placed in an upper cabinet in the kitchen. Safe and age appropriate toys, play equipment and materials were observed throughout the facility. LPAs did not observe Baby walkers, baby jumpers, baby exersaucers, baby bouncers/rockers or any other item that falls into that category in the facility.

The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible, there is a designated area for ill children as necessary in dining room area which is used for day-care. Per Licensee, there are no weapon/firearms in the home. There is a fire place that is properly screened and made inaccessible to children. The facility sketch is complete and current, there is working land line and cell phone. Fire/Disaster drills are maintained current. Last fire/disaster drills were completed on 11/30/2022.

Bathroom: LPAs observed toilet and faucet are clean and operable condition. LPAs observed licensee removing shampoos from the shower. LPAs did not observe any hazardous items.

Kitchen: Sharp utensils were stored in the upper kitchen cabinet. There were no open bottles or alcohol accessible to children. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located under the kitchen sink with an operational safety latch. Breakfast, lunch, AM, PM snacks and dinner. Licensee stated she currently is a participant in a food program.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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: FOWLIE-PETERS FAMILY CHILD CARE
FACILITY NUMBER: 364808486
VISIT DATE: 11/30/2022
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Outdoor: Children have access to the front yard area. The front/side yard is surrounded brick that is approximately 3 ft high and on top of the brick there is wrought iron fencing approximately 3 ft in length. Front yard is adjacent to a semi-main street area therefore, licensee advised that children must be supervised at all time in while playing in front/side yard area. Licensee states that she supervises children in the front yard area at all times and they are never left alone. LPAs observed in the front/side yard area is grass landscaping. LPAs observed that there were a good supply of toys in which the children can play with.

Advisory/Other: First Aid kit was observed with supplies readily available, including a thermometer. CPR/First Aid expires on 08/09/2024. Mandated Reporter is not maintained current. LPAs advice licensee to complete mandated reported and submit the certificate today, 11/30/22. LPAs reminded licensee mandated reporter training must be completed every 2 years.

Licensee stated she provides 24hr care and the following were reminded. Licensee is reminded that with 24hr care, she must adhere to the following:

- The provider must remain awake whenever children are awake.

- The door to the room where the provider is sleeping must remain open when the provider is sleeping.


- If the sleeping arrangements are not situated in such a way that the provider can be assured of hearing a child waken, a monitor system must be used, and must be maintained in good working order at all times.
- The home must be equipped with smoke alarms and a fire extinguisher approved for home use in or near all sleeping areas.
- Appropriate cribs or beds, complete with adequate and clean bedding and nightclothes, must be available.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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: FOWLIE-PETERS FAMILY CHILD CARE
FACILITY NUMBER: 364808486
VISIT DATE: 11/30/2022
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Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Children files were missing LIC995A

Licensee Fowlie-Peters 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.

LPAs discussed the safe sleep regulations with licensee Leyva and discussed the Child Care Licensing Safe Sleep web page 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) were discussed. Per licensee, the facility is not currently providing IMS. Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

A notice of site visit was given to licensee 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 Lewis-Peters along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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