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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820126
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:20:49 PM


Document Has Been Signed on 10/03/2023 01:20 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:FLORES FAMILY CHILD CAREFACILITY NUMBER:
364820126
ADMINISTRATOR:JESSICA FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 228-3343
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:14CENSUS: 4DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Licensee Jessica Flores TIME COMPLETED:
01:30 PM
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On October 3, 2023, at 10:10 a.m., Licensing Program Analyst (LPA) Kendal Zirbes met with Licensee Jessica Flores. The purpose of the inspection was to conduct a required one year inspection at the licensed facility. LPA disclosed the purpose of the inspection to the Licensee. When LPA arrived to the facility, the Licensee and one staff member was providing supervision to four children (three infants and one child over two years of age). Current days and hours of operation are Monday thru Friday 06:00am- 06:00pm.
Physical Plant: This is a single story house with five bedrooms, three bathrooms, kitchen, dining room, living room, attached garage, front and back yard with a in ground pool. Per Licensee the living room, kitchen, dining room, playroom, 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 by 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.
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. According to Licensee all cleaning products are stored in a inaccessible kitchen counter and in the laundry room. Sharp knives were stored on an inaccessible kitchen counter. Household medications were stored on a high inaccessible shelf in the living room and in the off limits bedrooms. Per recorded documentation Fire/earthquake drills were last completed in January 2023. LPA reminded the Licensee to conduct and document disaster drill every six months. The fire extinguisher was purchased in 2023. .
Safe and age appropriate toys, play equipment and materials were present. Smoke detector and carbon monoxide detector were observed in the facility. 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.
Report continued on page two
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
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 8


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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 10/03/2023
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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home has a fireplace, which was inaccessible via a glass barrier. The home has central heating and air conditioning.

Bathroom: Toilet, sink, faucet, were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.

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 advised the Licensee to place padding under the little tikes climbers which are currently placed on cement. The backyard is off limits to the child care children. The in ground pool is surrounded by a 5’ removable mesh fence and a wrought iron fence that is mounted into concrete and dirt.  The gates open away from the pool and are equipped with a self-closing, self-latching mechanism on top of the gate.  There are no items around the perimeter of the fence that would allow the fence to be climbable.  The licensee/applicant understands and agrees that the fence will remain in place whenever licensed care is provided.

Per Licensee, the family has three dogs and one cat. Per Licensee the animals do not interact with the child care children.

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Fire Drill Log, Roster, Postings, Safe Sleep. LPA observed the last documented fire/disaster drill occurred in January 2023. LPA reminded the Licensee that disaster drill/fire drills must be competed and documented every six months. An advisory notice was issued.


File Review: LPA reviewed five child files and two personnel records. One of five child files was missing documentation of their immunization's. LPA observed the current CPR/First Aid cards on file did not document the training was provided by a approved Emergency Medical Services Authority (EMSA). A advisory notice was issued.

Report continued on page three
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 10/03/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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:

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



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.

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.

Report continued on page four
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 364820126
VISIT DATE: 10/03/2023
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Report continued from page three

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 LPAs record review there were zero citations and four advisory notices issued today.

A notice of site visit was given 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 Jessica Flores.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 8