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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818016
Report Date: 04/28/2023
Date Signed: 04/28/2023 03:40:15 PM


Document Has Been Signed on 04/28/2023 03:40 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:CAMPOS FAMILY CHILD CAREFACILITY NUMBER:
364818016
ADMINISTRATOR:CAMPOS, MARIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 983-5269
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:14CENSUS: 4DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mariana Campos, LicenseeTIME COMPLETED:
04:00 PM
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On April 28, 2023, Licensing Program Analyst (LPA) Kuliema Calloway, met with Licensee who granted access. The purpose of inspection was to conduct a 1 Yr. Required Annual Inspection. Care and supervision are provided for a large family childcare with a maximum capacity of 14 children. Present in care are 4 children (one infant, 2 toddlers, and one school aged child) along with licensee and two assistants. Currently residing in the home is the licensee, their spouse, and one (1) adult child. All adults residing in the home have a Criminal Record Clearance (DOJ/FBI and Child Abuse Index Clearance. Licensee and LPA toured the home indoors and outdoors to ensure the home meets licensing requirements. Daycare operation hours are from 6:00 AM to 11:00 PM. Monday through Friday. Roster is maintained and emergency drills conducted every six months.
The Home is set up as follows:
Physical Plant: This is a one story 3-bedroom, 3-bathroom home with kitchen, dining area, childcare room, living room, laundry room, and garage. There are age-appropriate toys, books, play, and napping equipment. LPA observed and tested smoke detector and carbon monoxide detectors. Per licensee, the home is non-smoking. There is a designated area for ill child(ren)in the off-limits Bedroom in the front of the house. Per the licensee, there are no weapon/firearms on the premises. There is a fireplace that is covered with a shelf. All unused electrical outlets have safety plugs. LPA observed fire extinguisher that is FULL/green and meets standards established by the State Fire Marshall. The blind cords were tied up and high. Working telephone (cell phone). The home was inspected for safety, comfort, cleanliness, and proper ventilation. The home has central heating and air conditioning.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 364818016
VISIT DATE: 04/28/2023
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All windows have screens and are free of cracks, bugs, and debris.
Kitchen: The following are inaccessible: Sharp items and knives (knives are in the upper kitchen cabinet up high), there was no medication. Chemicals were stored. (kept in the off limits garage). Dining seating for at least six toddler age children and two school age children were observed. Refrigerator/ Freezer are working. The water is at a safe temperature between 105-120 degrees.
Children’s Bathroom #1: Toilets and faucets are clean and operable there were no soaps, mouthwash, shampoo, razors, nail polish or other chemicals or poisons.

Off Limits: Bedroom #1, Bedroom #2, Bedroom #3, and Bathroom #2. Poisons and cleaning items inaccessible to children (garage and laundry room).

Required Postings and Trainings Observed: Emergency Disaster Plan, Earthquake Preparedness Checklist, Notification of Parent’s Rights, Training: Mandated Reporter, CPR/First Aid are current, Immunizations: MMR, Influenza, negative TB skin test for licensee and assistants all were current.

Outside: The backyard was inspected; Fenced all around and gates were locked. AC unit is in the back yard on the left side of the home. LPA recommended the AC unit to have a cover. There was a locked storage shed that was checked. It had a living quarters and misc. items stored. There is a decorative water fountain in the backyard (no water) on the premises. There are two (2) dogs on the premises (vaccinated) that are accessible to the children. LPA suggested to the licensee, that the two dog do not interact with the children during day care operating hours.

Others: Incidental Medical Services (IMS) policy was discussed. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 364818016
VISIT DATE: 04/28/2023
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http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.The Safe Sleeping Regulation was shared with the licensee. All infants must be placed on their back, checked every fifteen (15) minutes, and licensee must keep a log. Toys and blankets are not allowed in the infant’s sleeping area while sleeping.
The following information 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. The licensee is reminded that 100% supervision is always required for all children. Capacity limits, parent/child roster maintenance, posting facility license, knowledge of Emergency Plan. All food is properly labeled if brought from child’s home; and all food is checked periodically for expiration dates. Licensee was advised how to access and Regulations for Family Child Care online at: www.ccld.ca.gov. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. A licensed child care provider, administrator, or employee of the licensed child day care facility shall complete an on-line Mandated Reporter Training and shall renew the training every two (2) year at: www.mandatedreporter.com 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 (LIC 624B). The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCLD office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Criminal Record Statement: 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 the initial presence in a licensed Family Child Care Home.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 364818016
VISIT DATE: 04/28/2023
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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. Safe Sleep: 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. Notice of Site Visit: A notice of site visit must remain posted for 30 days. Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Parent Notifications Requirements: Per the Health and Safety code (HSC) 1596.859, 1596.8895, and 1597.05 to improve transparency of licensing records and to ensure that the parents/guardians using the licensed childcare facility are aware of situations that present danger to the children. Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against Influenza, Pertussis, Rubella, Mumps, and Measles December 1 of each year. Type A citation: Type A citation(s) shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban).
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
Page: 4 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: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 364818016
VISIT DATE: 04/28/2023
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State law prohibits baby walkers, bouncy seats, exer-saucers, and any other items that fall into that category. Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
The Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
ü The On Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

ü **Incidental Medical Services (IMS) policy was discussed. Licensee will wait until facility opens to determine IMS needs. 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.htmSafe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

Licensee advised visit www.shotsforschool.org for Immunization information.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

There are no deficiencies cited. The home meets Title 22 Regulations.

Exit interview was conducted: A copy of this report, Notice of Site Visit were discussed and left with the Licensee at the facility.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
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