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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364810655
Report Date: 05/04/2022
Date Signed: 05/04/2022 11:30:13 AM


Document Has Been Signed on 05/04/2022 11:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:DE HARO FAMILY CHILD CAREFACILITY NUMBER:
364810655
ADMINISTRATOR:DE HARO, FLAVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 886-0254
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:14CENSUS: 3DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee Flavia De Haro TIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPA) Zirbes and Rodriguez met with Licensee, Flavia De Haro, who guided analysts on a tour of the facility for the One Year Required inspection. This is a one story four bedrooms, two bathroom, living room, kitchen, detached garage, and detached storage area. There are no pool/spa or body of water on the premises. Per Licensee, the Licensee is the only adult whom resides on the property. Upon arrival LPA observed one child in care. Current days and hours of operation are Monday thru Friday, 6:00am - 6:00pm.
Physical Plant: Child care is provided in the living area, kitchen, bedroom 1 (down hallway and across from bathroom), bedroom 2 (to the right of the bathroom), bathroom 1 (located in the hallway). Off limit areas include master bedroom, bedroom 4 (connected to bedroom 2), detached garage and detached storage area. The off limits areas were made inaccessible via locked doors. Licensee was reminded to ensure all off limits areas remain inaccessible to the child care children. 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. Fire/earthquake drills was last completed in April 2022. Documentation was maintained and up to date

Safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. 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. There are age appropriate napping equipment (cots, crib).

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SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DE HARO FAMILY CHILD CARE
FACILITY NUMBER: 364810655
VISIT DATE: 05/04/2022
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Per Licensee, there are no weapons or firearms on the premise. In addition, LPAs did not observe any weapons in the home. The home does not have a fire place. Two wall heaters were observed in the home. Each wall heater was surrounded by a secured fire place gate which prevented the children from having access to the heat source.

Bathroom: Shower/tub free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet are clean and operable.

Outdoor: The backyard was completely fenced. LPAs observed two climbing structures in the backyard, dramatic play area and child size tables and chairs. The large climbing structure had one swing and a slide. In addition there was a little tikes slide in the backyard. Climbing equipment was secured to the ground and placed on recycled rubber. LPAs observed two dogs during this inspection. The dogs were in an inaccessible gated area of the backyard. Per Licensee the dogs do not interact with the child care children. Licensee also stated the dogs were up to date on the required shots. LPAs observed the detached garage and detached storage shed (identified as a rental property on facility sketch) were inaccessible to the child care children at the time of this inspection. Per Licensee no one resides in the rental property.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 7/11/2023 and Mandated Reporter expires 2/6/2022 . 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. There are no window cords accessible to children.



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 three child files, and the Licensees file during this inspection. Files were complete during this inspection.
Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep, COVID-19 posters. Licensee stated she does not have child care insurance.
The following were observed/discussed and or provided: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A, LIC9148).

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SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DE HARO FAMILY CHILD CARE
FACILITY NUMBER: 364810655
VISIT DATE: 05/04/2022
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All adults living/residing in the home are fingerprint cleared and associated

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.

·On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com.



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SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DE HARO FAMILY CHILD CARE
FACILITY NUMBER: 364810655
VISIT DATE: 05/04/2022
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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 childcare facility are aware of situations that present the greatest danger to children.

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (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

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. Per Licensee IMS is being not provided at this time.
Licensee advised visit www.shotsforschool.org for Immunization information.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

There is an on-Duty Worker/Officer is available to answer any questions and concerns at
(661) 202-3318. Department hours of operation not including state holidays are Monday - Friday from 8:00am - 5:00pm Report continued on page five
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DE HARO FAMILY CHILD CARE
FACILITY NUMBER: 364810655
VISIT DATE: 05/04/2022
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies were observed during this inspection. The License has been asked to send an updated facility sketch to the Department by May 18, 2022.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Falvia De Haro.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC809 (FAS) - (06/04)
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