364813612-9-17-2024-12-CC-KZIS-D97RHZ-20240917130311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364813612
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:03:27 PM

Document Has Been Signed on 09/17/2024 01:03 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:	ACOSTA FAMILY CHILD CARE		FACILITY NUMBER:	364813612
ADMINISTRATOR:	ACOSTA, SHANNON & GILBERT		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 228-3365
CITY:	YUCCA VALLEY	STATE: CA	ZIP CODE:	92284
CAPACITY:	14	CENSUS: 9	DATE:	09/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Licensee Shannon Acosta		TIME COMPLETED:	01:15 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 September 17, 2024, at 09:25 a.m., Licensing Program Analyst (LPA) Zirbes met with Licensee Shannon Acosta who guided analyst on a tour of the home for the Annual/Random inspection. Upon arrival, LPA observed nine children (seven school age and two infants) with the Licensee and an assistant providing supervision. Based on LPA observation, the child care was meeting the staffing/ratio requirements at the time of this inspection. According to the Licensee currently living in the home are the Licensees and two children (11 and 16). All adults are associated and have eligible clearances. Current hours of operation are Monday to Friday 6:00am -6:00pm. Physical Plant: This is a one story, four bedroom, two bathroom home with kitchen/dining, living area, toy room and detached garage. The on limits areas are the toy room, kitchen/dining room, living room, bathroom (located in hallway), and backyard. The off limit areas consist of all bedrooms, the primary bathroom, detached garage and a portion of the backyard. The off limits areas were inaccessible via child safety gates and locked doors. According to the statements of the Licensee there are zero bodies of water on the property. 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. During the inspection, LPA observed cleaning products and medications stored in a magnetic child safe cabinet in the kitchen. Sharp knives were stored on a high inaccessible cabinet. LPA observed smoke detectors and carbon monoxide detectors in the home. The alarms were tested during the inspection and found to be in working order at the time of the inspection. A fire place and a wood burning stove were located in the living room. Fire place and wood burning stove were inaccessible via a child safety gate. LPA did not observe baby bouncers/saucer chairs, or any recalled and or prohibited toys on the premises. Per Licensee, there are zero firearms or weapons stored in the family child care. According to information received from the Licensee, the firearms are stored in accordance with the regulations. 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: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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: ACOSTA FAMILY CHILD CARE	FACILITY NUMBER: 364813612
	VISIT DATE: 09/17/2024

NARRATIVE

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Report continued from page one

According to the documentation the fire extinguisher was serviced in 2024.

Bathroom: (located in the hallway): Toilet, sink, shower were clean and sanitary.

Outdoor: The backyard is completely fenced. One section of the outdoor area is off limits and is used by the family animals and household storage. LPA observed a large wooden climbing structure which was secured to the ground and place on sand/dirt. LPA also observed multiple dramatic play houses.

Per conversation with the Licensee there is one dog and three cats in the home. Per Licensee the cats interact with the children and the dog does not interact with the children. Per Licensee, dogs and cats are current on shots and licensing.

At the time of this inspection, the exit doors of the Large Family child care were not single action. LPA advised the Licensee of the requirement and requested the Licensee comply with the regulation within 30 days.

Record Review: LPA reviewed five child files, and the Licensees files. Per LPA review of the child files, one of five files was missing immunization documentation. A technical advisory notice was issued. The personnel files were complete and contained all required information.

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.
The following was discussed with the licensee:
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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: ACOSTA FAMILY CHILD CARE	FACILITY NUMBER: 364813612
	VISIT DATE: 09/17/2024

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Report continued from page two
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-andresources/
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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

During the exit interview, the Licensee Shannon Acosta, confirmed that there are no Registered Sex
Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

As a result of this inspection, two technical advisory notices was issued.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Shannon Acosta. Appeal Rights were provided.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

LIC809 (FAS) - (06/04)

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