364810655-6-21-2023-12-CC-KZIS-CSZUE3-20230621153028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364810655
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:30:36 PM

Document Has Been Signed on 06/21/2023 03:30 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:	DE HARO FAMILY CHILD CARE		FACILITY NUMBER:	364810655
ADMINISTRATOR:	DE HARO, FLAVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 886-0254
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY:	14	CENSUS: 3	DATE:	06/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee Flavia De Haro		TIME COMPLETED:	03:45 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 June 21, 2023 at 1:00 p.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Required One year inspection and met with Licensee, Flavia De Haro. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. A total of three children were present during the inspection, (One preschool age child, two school age children). Licensee accompanied LPA inside and out of the facility during this inspection. Per Licensee, the living room, dining room, kitchen, bedroom 1 (down hallway and across from bathroom), bedroom 2 (to the right of the bathroom), bathroom 1 (located in the hallway) and the backyard are utilized for child care activities. 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. Currently living in the home is the Licensee. Current days and hours of operation are Monday to Friday 7:00 a.m, to 6:00 p.m. 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. Per LPAs observations and conversation with Licensee all cleaning products are stored the off limits areas of the home. Sharp knives were stored in a cabinet equipped with a magnetic child safety lock. Kitchen items containing sharps edges were stored in drawers equipped with magnetic child safety locks. Household medications are stored the off limit areas of the home. Per recorded documentation Fire/earthquake drills were last completed in April 2023. LPA observed a 2A10BC fire extinguisher located in the kitchen. Per documentation the fire extinguisher was serviced in April 2023. Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were observed in the home. Electrical outlets were inaccessible. Baby bouncers, saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were not 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: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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: DE HARO FAMILY CHILD CARE	FACILITY NUMBER: 364810655
	VISIT DATE: 06/21/2023

NARRATIVE

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Report continued from page one
Per Licensee, there zero firearms stored in the home. The home does not have a fireplace or open face heaters. The home has central heating and window air conditioning units.
Bathroom: Toilet, sink, faucet, shower were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.
Out door: The backyard was completely fenced. LPAs observed one climbing structures in the backyard, dramatic play area and child size tables and chairs. The large climbing structure had two swings and a slide. Climbing equipment was secured to the ground and placed on recycled rubber. LPAs observed the detached garage and detached storage shed (identified as a rental property on facility sketch) in the backyard. Both areas were inaccessible via locked doors at the time of this inspection. Per Licensee no one resides in the rental property.

Per Licensee there are two dogs in the home. According to the Licensee the dogs are current on shots and licensing. Per Licensee, the dogs do not interact with the childcare children.

LPA reviewed three child files and the Licensees file. Based on LPAs record review the child files were complete and included all required information. Based on LPA record review, the Licensee completed the General Mandated reporter training on 2.6.22. LPA advised the Licensee that the Mandated Reporter training specific for Child Care Providers had to be completed. In addition, the Licensees file did not contain documentation of the required immunization's (influenza, Pertussis, Measles, TB). LPA advised the Licensee to add immunization paperwork to the Licensees file. Two technical advisory notices was issued.

Documents Reviewed/observed Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).
The following was discussed with the licensee:

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. 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

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: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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: DE HARO FAMILY CHILD CARE	FACILITY NUMBER: 364810655
	VISIT DATE: 06/21/2023

NARRATIVE

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Report continued from page two

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

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.
LPA reminded the Licensee to report all unusual incidents to the Palmdale Regional Office.

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

Based on LPAs record review there were zero citations issued today. Two advisory notices were issued.

Exit interview conducted and report was reviewed with the licensee Flavia De Haro.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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