364819059-7-7-2023-12-CC-BBEO-CTHUEW-20230707153148

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364819059
Report Date: 07/07/2023
Date Signed: 07/07/2023 03:33:24 PM

Document Has Been Signed on 07/07/2023 03:33 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:	COUSE SARAH FAMILY CHILD CARE		FACILITY NUMBER:	364819059
ADMINISTRATOR:	COUSE, SARAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 843-5979
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY:	14	CENSUS: 11	DATE:	07/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Sarah Couse		TIME COMPLETED:	12:15 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 07/07/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Couse Family Child Care Home. Upon arrival, the LPA met with the Licensee, Sarah Cause, who guided the LPA on a tour of the facility. Family members residing in the home include 1 adult (licensee) and one adult son. Per the Licensee, the hours of operation are Monday through Friday, 6:00AM to 5:00 PM. Per licensee, no overnight care is provided. Upon arrival, LPA observed 11 children in care and two adults providing care and supervision. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed. Physical Plant: This is a two-story, 3-bedroom, 2-bathroom home with a kitchen, living room, dining area, day care room and backyard. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows are free of cracks, bugs, and debris. All electrical outlets are covered. Main Care Area: Main care is provided in the converted patio. Children use the bathroom located on the hallway on the right-hand side. Children have access to the kitchen and backyard. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises of this facility. Per licensee, there is a designated area for ill/sick children in the living room

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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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Document Has Been Signed on 07/07/2023 03:33 PM - It Cannot Be Edited

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: COUSE SARAH FAMILY CHILD CARE	FACILITY NUMBER: 364819059
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above. Licensee does not have a file with the assistant's records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of employee's file, which will include a confirmation of enrollment to the health and safety training.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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: COUSE SARAH FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 07/07/2023

NARRATIVE

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Electrical outlets are covered and made inaccessible to children. There is one pet in the facility.

Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.
Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit is located in the kitchen above the refrigerator and was observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. Transportation is not currently offered.
LPA observed a required fire extinguisher (2A10BC) reading in Green and currently serviced.

Fireplace: The fireplace was observed in the living room and is screened p it inaccessible to the children. Per LPA’s observations, there were no hanging window blind cords.
Medications/ Hazardous Materials: Medications are in the off-limits master bedroom. Cleaning compounds were observed to be located in the kitchen above the refrigerator. Per licensee, there are No Firearms at the facility at this time. The facility currently does have childcare insurance.

Incidental Medical Services (IMS): 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 Licensee will not be providing IMS to the children at this time.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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: COUSE SARAH FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 07/07/2023

NARRATIVE

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Children's bathroom: Children use the bathroom down the hallway on the right hand-side. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition. Toilet and faucets are clean, safe, and operable.

Kitchen/Dining Room: The kitchen is accessible to children. LPA observed safety latches in the cabinets. Sharp knives are inaccessible to children in care, they are placed in an upper cabinet. Cleaning compounds are kept on top of the refrigerator.

Backyard/Outdoor areas: The backyard is completely fenced (with cement block). LPA inspected and was observed the backyard to be free of hazards, lose or sharp parts and tools. LPA observed appropriate and safe toys in the play area. Per licensee and LPA’s observations, there is an inflatable pool that day care use during the summer months, the pool was deflated and empty during at the time of the visit. LPA reminded licensee that such pools need to be emptied out and deflated after use. LPA informed licensee to ensure she provides direct supervision to children while outside particularly when the pool is inflated. There is a storage shed that remains locked and inaccessible to children.

Off-limits: Off-limit areas include all bedrooms and bathroom #2, made inaccessible by a safety gate. The laundry and garage are inaccessible to children the door remains locked during business hours.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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: COUSE SARAH FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 07/07/2023

NARRATIVE

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SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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: COUSE SARAH FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 07/07/2023

NARRATIVE

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Records: Children’s and infant’s records were observed to be incomplete; Individual Sleeping Plan and Sleep Logs were not in the children’s files. Staff member’s files were not observed, per licensee, she does not currently have a file for her. A type B Violation was issued for this deficiency. Licensee’s CPR/First Aid is maintained current. It expires on 10/2024. Mandated reporter in file was not the correct training. Licensee agrees to send proof of certificate by 07/07/2022. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 07/07/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.
Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP and LIC 9227 (Individual Sleeping Plan). The Licensee was reminded that supervision is always required for children in care.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Couse 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 Couse 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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: COUSE SARAH FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 07/07/2023

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 26 27 28 29 30 31 32	One Type B Violation has been issued during today’s inspection. 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 Couse, along with her appeal rights and Notice of Site Visit.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC809 (FAS) - (06/04)

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