364814054-12-5-2019-12-CC-JNEL-BJKV7H-20191205151110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364814054
Report Date: 12/05/2019
Date Signed: 12/05/2019 03:11:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	VALDEZ-CARRILLO FAMILY CHILD CARE		FACILITY NUMBER:	364814054
ADMINISTRATOR:	CARRILLO, DIANE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 949-5690
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	14	CENSUS: 7	DATE:	12/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Diane Carrillo		TIME COMPLETED:	03:25 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	Licensing Program Analyst (LPA) Neal met with licensee, Diane Carrillo for the purpose of an Annual/Random inspection. This is a single story 2 bedroom, 2 bathroom home with kitchen, living room, family room, laundry room and adjacent child care room separate from the rest of the home. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 2 adults (licensee and parent). Licensee's assistant (CBCB cleared) and 7 child care children were present during this inspection. Incidental Medical Services (IMS) were discussed. Parents enter child care through a side door in the driveway. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds (in the main house), medicines, and hazardous items that can pose a danger to children. Main care is provided in a separate detached room behind the main house. Children use the bathroom located inside the child care room. Children have access to a portion of the backyard. Off limit areas include the home's entire main house and the gated portions of the backyard. There is no fireplace in the child care area. Medicines are kept in a locked box under licensee's desk or in the mini refrigerator (with a lock). Sharp knives are stored in the main house, inaccessible to children. Children's roster is current. Fire/earthquake drills are also current. A sample of children's records were reviewed.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: VALDEZ-CARRILLO FAMILY CHILD CARE	FACILITY NUMBER: 364814054
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/20/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home. This requirement is not met as evidenced by: LPA observed sink in the child care bathroom is currently backed up with water which is a potential Health and Safety
	8 9 10 11 12 13 14	risk.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: VALDEZ-CARRILLO FAMILY CHILD CARE	FACILITY NUMBER: 364814054
	VISIT DATE: 12/05/2019

NARRATIVE

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Children play in the backyard's shaded concrete area between the main house and the child care room. LPA observed age appropriate toys for active play. Licensee has 1 small dog. There is a locked shed in the backyard. Declaration obtained regarding area of the backyard that is now off-limits to children. Licensee will inform Licensing when/if she intends to resume using the backyard area on side of child care.

Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. Licensee has napping equipment on the premises (mats and pack 'n plays) in good condition. The required fire extinguisher is in operable condition. Home has AC and heat. Licensee's CPR/First Aid expires 1/13/2020. Licensee was reminded that Mandated Reporter training for child care must be completed every 2 years for licensee's and anyone assisting in child care. LPA observed required documents posted.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family child 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: VALDEZ-CARRILLO FAMILY CHILD CARE	FACILITY NUMBER: 364814054
	VISIT DATE: 12/05/2019

NARRATIVE

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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12 month period, PER PERSON.

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 advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. Handout on Safe Sleep concepts was given and discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

1 Type B deficiency was cited during this inspection. LIC 809D was given. Appeal Rights were also given to licensee.
Exit interview was conducted, report was read and a copy was provided to licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

LIC809 (FAS) - (06/04)

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