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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817785
Report Date: 10/26/2021
Date Signed: 10/26/2021 03:00:01 PM

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:CISNEROS FAMILY CHILD CAREFACILITY NUMBER:
364817785
ADMINISTRATOR:CISNEROS, ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 949-4466
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:14CENSUS: 9DATE:
10/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Isabel CisnerosTIME COMPLETED:
03:16 PM
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Licensing Program Analyst (LPA) Thompson-Miller met with Licensee Isabel Cisneros and assistant Valeria Rodin (Cisneros). Assistant Ms. Rodin guided analyst on a tour of the facility for an One Year Required Inspection. This is a single story 5 bedroom, 3 bathroom home with kitchen/dining, formal dining room, living room, laundry room, playroom, enclosed patio and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include 4 adults (licensee, licensee spouse, licensee adult daughter and her spouse) and two children. Present during inspection were licensee, assistant, and nine children (3 infants and 6 preschool). Incidental Medical Services (IMS) policy was discussed. Days/Hours of operation Monday through Friday, 6AM to 6PM.

Physical Plant: Main care is provided in Bedroom #5 at end of hallway on the right and the playroom. Children use the bathroom in hallway on the right. Children have access to the formal and living rooms. Off limit areas include the Bedroom #1 through #4, bathroom #1 and #3, garage and laundry (inside garage) have a key lock. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry), medicines and hazardous items (sharp knives in upper cabinet above the kitchen sink-safety latch) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. 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 is complete and current, there is working telephone (land line and cell).



Kitchen/bathroom: Bathtub and shower are free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean and operable, home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located in off limits laundry room. Spray solutions are in Bedroom #5 in a locked cabinet (high cabinet). No chemicals in the kitchen were observed to be accessible. Children bring own lunch and snacks. Facility does provide additional snacks.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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 3
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: CISNEROS FAMILY CHILD CARE
FACILITY NUMBER: 364817785
VISIT DATE: 10/26/2021
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Outdoor: The backyard is completely fenced. There is a jungle gym that is anchored, Little Tikes toys, padded/gated infant area on the patio, swing that is anchored, garden (fenced), kennel in the rear and gazebo. There are two dogs (kennel). 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 swing/slide that is anchored and other age appropriate toys observed to be free of hazards. There two separate shaded areas. There are 2 large dogs (kennel) and one small cat (off limits bedroom).

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid 12/21/2021. Electrical outlet are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. Window cords throughout the home are inaccessible. There is cushioning or resilient material around the play structures.

Documents Provided and or Discussed: The following were observed to be in regulation of Title 22 requirements: Fire Drill Log is current, Roster is up to date, Postings were observed and meet Title 22 requirements, Safe Sleep and Lead Poisoning flyer's observed, Staffing and Ratio in regulation. Licensee stated currently does have child care insurance.

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.


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

The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed; Licensee were reminded that 100% supervision is required at all times to children in care; Licensee were made aware that it is her/their 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; Regulation prohibits the smoking of any kind during the operation of the day care.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CISNEROS FAMILY CHILD CARE
FACILITY NUMBER: 364817785
VISIT DATE: 10/26/2021
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The following was discussed with the Licensee:

Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (unusualincidentreport@dss.ca.gov).

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

No deficiencies. Exit interview conducted and a copy of this report was read and provided to Licensee Assistant Valeria Rodin (Cisneros) on this date.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3