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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364811907
Report Date: 11/30/2022
Date Signed: 11/30/2022 12:17:35 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:CURTIS FAMILY CHILD CAREFACILITY NUMBER:
364811907
ADMINISTRATOR:CURTIS, PARISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 522-2208
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:14CENSUS: 8DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Licensee Paris Curtis TIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee, Paris Curtis who guided analyst on a tour of the facility for the One Year Required inspection. This is an single story house with four bedrooms, two bathrooms, kitchen, dining room, living room, detached garage, front and backyard. Per Licensee the living room, dining room, kitchen, one bathroom (hallway) two bedrooms (2nd and third bedrooms on right side of hall) and backyard are utilized for childcare activities. The off-limits areas consists of two bedrooms (office and primary), the bathroom within the primary bedroom, and the garage. These areas have been made inaccessible via the use of door locks and child safe door knob cover. Upon arrival, LPA observed eight children in care (three infants and five preschool age children) with the Licensee and staff 1 (S1) providing supervision. According to the Licensee currently living in the home are the Licensee, and adult 1. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 5:00am - 6:00pm.
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 and LPA observation cleaning products were located in hallway closet which was equipped with a safety latch. Sharp knives were stored in a kitchen cabinet equipped with a child safety lock. According to the Licensee all household medications are stored in the primary bathroom and a high cabinet above the kitchen sink. Per recorded documentation Fire/earthquake drills were completed 2022, the fire extinguisher was purchased within the year according to the Licensee. LPA advised the Licensee to keep a copy of the receipt documenting the purchase date.
Safe and age appropriate toys, play equipment and materials were present inside the home. 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. One of the bedrooms would be utilized as the designated area for ill children in the child care. Report continued on page two
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
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)
Page: 1 of 5


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: CURTIS FAMILY CHILD CARE
FACILITY NUMBER: 364811907
VISIT DATE: 11/30/2022
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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home does not have a fireplace. The home does not have window blinds in the sleeping areas.

Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.

Outdoor: The backyard had a covered patio and additional areas for the children to engage in gross motor and fine motor activities. The Licensee had age appropriate bikes, little tikes climbing equipment, a bike path, large climber and a octagon climber. The climbing equipment was secured to the ground and was placed on rubber padding and artificial grass. LPA observed the octagon climber was within two feet of a tree and near the cement bike path. LPA advised the Licensee to ensure all climbing equipment meets the manufactures requirements regarding the fall zones surrounding the climbing equipment. A technical advisory notice was provided. LPA reminded the Licensee to regularly monitor the play area for potential hazards.

Per Licensee, the family has zero pets.

CPR/First Aid expires 6/5/2023.



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 eight child files, the Licensees, one household member file and one staff file. Based on LPAs record review child files and household files contained all required information. Staff 1 file did not have a completed mandated reporter certificate. Per conversation with the Licensee S1 has not completed the mandated reporter training. A type B citation was issued for this deficiency. Refer to LIC 809D.

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

Report continued on page three
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
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: CURTIS FAMILY CHILD CARE
FACILITY NUMBER: 364811907
VISIT DATE: 11/30/2022
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Report continued from page two
The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

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



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.

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/process.

Based on LPAs record review there was one type B citation issued and one advisory notice.

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

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
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)
Page: 3 of 5
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: CURTIS FAMILY CHILD CARE
FACILITY NUMBER: 364811907

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

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
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Based on record review, the licensee did not comply with the section cited above in one of two staff files. S1 has not completed the mandated reporter training as required, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/14/2022
Plan of Correction
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Per Licensee, Staff will complete the mandated reporter training as required. A copy of the training certificate will be submitted the Department.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
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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