<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820126
Report Date: 05/26/2022
Date Signed: 05/26/2022 04:18:58 PM


Document Has Been Signed on 05/26/2022 04:18 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:FLORES FAMILY CHILD CAREFACILITY NUMBER:
364820126
ADMINISTRATOR:JESSICA FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 228-3343
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:14CENSUS: 9DATE:
05/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Licensee Jessica Flores TIME COMPLETED:
04:30 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) Zirbes met with Licensee, Jessica Flores, who guided analyst on a tour of the facility for the One Year Required inspection. This is a single storey house with five bedrooms, three bathrooms, kitchen, dining room, living room, attached garage, front and back yard with a pool. Per Licensee the living room, kitchen, dining room, left hallway bathroom, and front patio are utilized for family child care activities. Per licensee the off-limit areas of the home include all bedrooms (secured locked door knobs), master bathroom, bathroom down the hall to the right, backyard and garage. Currently residing in the home are the is the licensee, and five adults. Upon arrival LPA observed nine children in care with the Licensee, staff 1 and staff 2 providing supervision. Current days and hours of operation are Monday thru Friday 06:00am- 06:00pm.

Physical Plant: 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. All medications and sharp knives were stored in an inaccessible plastic storage bin located in the kitchen. Due to the ages of the children currently enrolled, the medications were currently inaccessible. Cleaning products were located in the off limits areas of the home. Fire/earthquake drills was last completed in May 2022. Documentation was maintained and up to date

Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The family room is the designated area for ill children in the child care. There are age appropriate napping equipment (play yards and mats).

Report continued on page two
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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 7


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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 05/26/2022
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
Report continued from page one
Per Licensee, there are zero firearms stored in the home. The home has a fire place located in the living room, which was made inaccessible via glass door barrier. The home has central heating and AC.

Bathroom: Toilet, sink faucet were clean and operable. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. A changing table was located in the living room.

Outdoor: The front patio is completely fenced and is used by the children for outdoor play. The outdoor play area was inspected and play equipment was observed to be free of hazards. LPA observed bikes and little tikes climbing equipment. LPA observed a small tear in the plastic of one of the little tikes climbing toys. LPA reminded the Licensee to regularly monitor the play equipment for potential hazards.

The backyard is off limits to the child care children. LPA and the Licensee toured the off limits area. A in-ground swimming pool was present in the off limits backyard area. At the time of this inspection, the removable mesh fence surrounding the pool was ripped and approximately ten sections of the two foot mesh panels were missing. In addition the exit alarm installed on the door in the kitchen/family room that leads directly to backyard did not sound an alarm when the door opened. Therefore the exit alarm was not in working order. Per License the mesh fence was broken during the strong winds two to three weeks ago. LPA and Licensee discussed that the in ground pool must be surrounded by a fence that meet regulation 102417(g)(5)(A). Licensee stated she plans to install a new wrought iron fence and will submit a plan to the Department. Based on LPAs observations the pool was accessible to the children in care. This poses an immediate risk to the children in care. A type A citation was issued. Furthermore, when the winds destroyed the mesh fence, the Licensee should have reported this unusual incident to the Department. Due to the Licensee failing to report that the in-ground pool was not surrounded by fence, the Licensee is being issued a type B citation. The Licensee will install exit alarms on the doors and windows that lead from the on limits areas to the backyard.

Per Licensee, the family has five dogs who are current on their shots. Per Licensee the dogs do not interact with the child care children.

CPR/First Aid expires 10/2023 and mandated reporter training expires on 8/27/2022. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 05/26/2022
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
Report continued from page two

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.

LPA reviewed nine child files, the Licensees and two staff file during this inspection. Files were complete during this inspection. All adults living/residing in the home are fingerprint cleared and associated

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep, COVID-19 posters. Licensee stated she does not have child care insurance.
The following were observed/discussed and or provided: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A, LIC9148).

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her 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



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). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

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 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.

Repot continued on page four

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 05/26/2022
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
Report continued from page three

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.


On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com.

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children.

§1597.622 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, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year

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. Per Licensee IMS is being not provided at this time. Report continued on page five
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 05/26/2022
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
Report continued from page four

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

There is an on-Duty Worker/Officer is available to answer any questions and concerns at
(661) 202-3318. Department hours of operation not including state holidays are Monday - Friday from 8:00am - 5:00pm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Based on LPA observation a type A citation was issued today for regulation 102417(g)(5) Operation of a Family Child Care Home. In addition civil penalties were issued. Furthermore, two type B citations were issued for reporting requirements and the fire extinguisher not meeting the State Fire Marshall requirements. Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days, in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Jessica Flores.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 05/26/2022 04:18 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, the licensee did not comply with the section cited above when the in-ground pool was not inaccessible to the children when the removable mesh fence was torn and missing sections therefore the pool was not surrounded by a fence, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
1
2
3
4
The Licensee will install exit alarms on the doors and windows that lead to the area with the pool. Licensee will submit receipts to the Department. Licensee will submit a plan to the Department by 5/30/22 detailing the new fence installation plan
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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 05/26/2022 04:18 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPAs observation and interviews, the licensee did not comply with the section cited above when the 2A10BC fire extinguisher that was purchased on 1/9/2020 has not been serviced or replaced. Therefore the fire extinguisher does not meet the State Fire Marshall standards, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2022
Plan of Correction
1
2
3
4
Per Licensee a new 2A10BC fire extinguisher will be purchased. A copy of the receipt will be submitted to the Department as proof.
Type B
Section Cited
CCR
102416.2(b)

102416.2 (b) Reporting Requirements
The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on an interview with the Licensee, the licensee did not comply with the section cited above when the Licensee did not report that the winds took down the fence that surround the in ground pool. This incident occurred two to three weeks ago. This is an unusual incident that should have been reported to the Department. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2022
Plan of Correction
1
2
3
4
Per Licensee, she will review the reporting requirements and send documentation to the Department that the section was reviewed.

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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7