364808491-11-14-2022-12-CC-KZIS-CL6SZL-20221114131920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364808491
Report Date: 11/14/2022
Date Signed: 11/14/2022 01:19:28 PM

Document Has Been Signed on 11/14/2022 01:19 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:	BROWN FAMILY CHILD CARE		FACILITY NUMBER:	364808491
ADMINISTRATOR:	BROWN, ZENNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 693-7500
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY:	14	CENSUS: 5	DATE:	11/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Licensee, Zenna Brown		TIME COMPLETED:	01:30 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	Licensing Program Analyst (LPA) Zirbes met with Licensee, Zenna Brown who guided analyst on a tour of the facility for the One Year Required inspection. This is single story home with four bedrooms, two bathrooms, kitchen, dining room, living room, child care room (bonus room) front and backyard and a detached garage. Per Licensee, the living room, kitchen, dining room, hallway bathroom, bonus room and front yard are utilized for the family child care activities. Per licensee off-limit areas of the home are all four bedrooms, master bathroom, detached garage and the backyard. The off limits areas were inaccessible via locked doors. Upon arrival, LPA observed five children in care (one infant, three preschool and one school age child) with the Licensee and staff 1 providing supervision. Currently living in the home are the Licensee, three adult children and one minor child. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Sunday 23 hours a day. 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 locked cabinet within the kitchen. Sharp knives are stored in a high inaccessible kitchen cabinet. Household medications are stored in the locked master bedroom. Per recorded documentation Fire/earthquake drills were last completed in July 2022. According to the Licensee the fire extinguisher was purchased within the past 12 months. LPA advised the Licensee to keep a copy of the receipt with the facility records. Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes in 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 living room is the designated area for ill children in the child care. Report continued on page two

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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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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: BROWN FAMILY CHILD CARE	FACILITY NUMBER: 364808491
	VISIT DATE: 11/14/2022

NARRATIVE

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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home has two fireplaces, located in the living room and the bonus room. The fireplaces were inaccessible via metal fire place screens. The home has zero window blinds.

Bathroom: Toilet, sink, faucet shower were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. A changing area is in the living room of the home.

Outdoor: The front yard was fully enclosed via a chain link fence. The area consists of grass. No safety concerns were observed. The backyard is off limits and according to the Licensee there are zero bodies of water on the premises.

Per Licensee, the family has three dogs who are current on shots. Per Licensee, the dogs do not interact with the child care children.

CPR/First Aid expires 09/11/23 and mandated reporter training expires on 10/31/24.

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 six child files, the Licensees, one staff members, and two household files. Based on LPAs record review the staff and child files were complete and included all required information.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep.

The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

Report continued on page three

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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: BROWN FAMILY CHILD CARE	FACILITY NUMBER: 364808491
	VISIT DATE: 11/14/2022

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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

Based on LPAs record review there were zero citations issued today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Zenna Brown

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC809 (FAS) - (06/04)

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