364813379-10-30-2023-12-CC-JTAO-CX4RKW-20231030130614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364813379
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:06:21 PM

Document Has Been Signed on 10/30/2023 01:06 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	GRAJEDA FAMILY CHILD CARE		FACILITY NUMBER:	364813379
ADMINISTRATOR:	GRAJEDA, LEONORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 241-0749
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92394
CAPACITY:	14	CENSUS: 3	DATE:	10/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Leonora Grajeda, Licensee		TIME COMPLETED:	01:20 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 10/30/23 Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee Leonora Grajeda who guided analyst on a tour of the facility for an One Year Required Inspection. This is a single story 4 bedroom, 2 bathroom home with kitchen/dining, family room (converted garage), living room, pantry and separate detached garage (backyard). There is no pool/spa on the premises. Upon arrival LPA observed 3 children (one infant, two preschool children) along with the Licensee. Days and hours of operation are Monday through Friday 6AM to 6PM. Family members residing in the home include 2 adult (licensee, licensee spouse) and no minor children. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in family room. There is a gated area in the family room for infants activity. Children have access to the living room. Children use the bathroom in hallway on the left. There is a gate separating the kitchen-family room/child care. Off limit areas include all bedrooms, bathroom #2 and pantry (washer/dryer and refrigerator inside) and detached garage. The water heater is now used as a linen closet (locked). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (pantry and under the sink- locked), medicines (coat closet at entrance on right) and hazardous items (sharp knives in cabinet under the sink- locked) that can pose a danger to children. Fire/earthquake drills complete and maintained current:08/30/2023. Roster complete and maintained current. There is a designated area for ill children as necessary in the living room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. There are no weapon/firearms in the home. The facility sketch observed and will be updated to reflect the water heater change and add the 2nd linen closet at end of the hallway. There is working telephone (land line and cell). All poisons, medication and cleaning items are inaccessible to children. No Fireplace.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GRAJEDA FAMILY CHILD CARE	FACILITY NUMBER: 364813379
	VISIT DATE: 10/30/2023

NARRATIVE

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Safe and age appropriate toys, play equipment and materials. 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 age appropriate napping (mats/playpen) equipment. There are no window cords accessible to children.

Bathroom: Shower is free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean and operable. Cleaning supplies are located in the pantry.

Kitchen: The home has a clean and fully stocked clean refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, snacks and dinner are provided. Licensee currently does not have a food program. Hazardous items (sharp knives) that can pose a danger to children are inaccessible. Sharp items, plastic bags, cleaning items, no chemicals in the kitchen were observed accessible. Food brought from the children’s home is labelled and dated.

Outdoor: The backyard is completely fenced. There is a wooden jungle gym and swing/slide set that are anchored. There is an octagon climbing set, barbecue grill covered, wooden chips on ground for cushion, tether ball, two large sheds with key lock and two medium size dogs (in gated area in backyard on the right-kennels). The detached garage has a key lock (inaccessible). There is chain link separating the play area from the driveway (51 inches height). Licensee reminded to supervise children while in the backyard. The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises. There is a gate on the left and right side of the yard. Licensee currently has 5 total pets on the premises.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has CPR/First Aid 08/20/2024 and Mandated Reporter 08/16/2024. 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GRAJEDA FAMILY CHILD CARE	FACILITY NUMBER: 364813379
	VISIT DATE: 10/30/2023

NARRATIVE

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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Safe Sleep Log. Licensee stated currently does not have child care insurance.

Licensee Grajeda 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 Grajeda 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.

No deficiencies have been cited at this time.

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 Leonora Grajeda, along with her appeal rights and Notice of Site Visit.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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