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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841901
Report Date: 05/19/2023
Date Signed: 05/24/2023 10:02:59 AM


Document Has Been Signed on 05/24/2023 10:02 AM - 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:ARCHILA FAMILY CHILD CAREFACILITY NUMBER:
364841901
ADMINISTRATOR:VILMA ARCHILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 628-6705
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:14CENSUS: 9DATE:
05/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Vilma AchilaTIME COMPLETED:
12:50 PM
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On 05/19/23, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Archila Family Child Care Home. Upon arrival, the LPA met with the Licensee, Vilma Archila, who guided the LPA on a tour of the facility. Family members residing in the home include 2 adults (licensee and spouse) and 4 minor children. All adults living in the house have been background cleared. Per the Licensee, the hours of operation are Monday through Friday, 5:00AM to 6:00 PM. Per licensee, no overnight care is provided. Upon arrival, LPA observed 9 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 one-story, 5-bedroom, 2-bathroom home with a kitchen, living room, dining area, family room and garage. The garage is off-limits. 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 living groom, family room, bedroom #1 and backyard. Children use the bathroom located down the hall to the left. 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. Cots are provided for nap time. Children nap in the in bedroom #1 and family room (day care area).

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023
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: ARCHILA FAMILY CHILD CARE
FACILITY NUMBER: 364841901
VISIT DATE: 05/19/2023
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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 day care area in an upper cabinet. The First Aid Kit was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. Transportation is currently offered; proof of vehicle insurance was observed. 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 with a metal gate. Per LPA’s observations, there were no hanging window blind cords.

Medications/ Hazardous Materials: Medications are kept in a closet in an upper shelf in the hallway, inaccessible to children. Cleaning compounds were observed to be in the kitchen in a lower cabinet with safety latches. Per licensee, there are no Firearms at the facility. The facility currently does not have childcare insurance.


Records: Children’s and infant’s records observed to be incomplete. There are two children that do not have files. Type B violation was for this violation. CPR First Aid is maintained current, it expires 04/13/2025. Mandated reporter is maintained current, it expires on 09/23/2023. Per licensee, her assistant does not currently have the Health and Safety Training, a Type B citation was issued for this violation. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 04/18/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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: ARCHILA FAMILY CHILD CARE
FACILITY NUMBER: 364841901
VISIT DATE: 05/19/2023
NARRATIVE
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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.
Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP and LIC 9227 (Individual Sleeping Plan). LPA provided LIC311D Forms/Records to Keep in your Family Child Care Home. 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 was advised to sign up receive the Provider Information Notices (PIN), to obtain the latest updates on new polices and regulations. Sign up with your email to the following address: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe

Licensee Archila 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.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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: ARCHILA FAMILY CHILD CARE
FACILITY NUMBER: 364841901
VISIT DATE: 05/19/2023
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Children's bathroom: Children use the bathroom down the hallway to the left. The bathroom was clean and sanitized but not in good repair. LPA observed licensee remove shampoos from the bathroom’s shower. 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 not currently off limits. There is no physical barrier to make it off limit. LPA observed lower kitchen cabinets and drawers with safety latches on them. Cleaning compounds are store in a lower kitchen cabinet, secured with a safety latch. Sharp knives were observed to be inaccessible to children and placed in a locked pantry area.

Backyard/Outdoor areas: The backyard is completely fenced (cement block and chain linked fence). Per licensee and LPA’s observations, there are no pools or bodies of water in the premises. LPA observed backyard to be free of tools, hazardous items, and debris.

Off-limits: Bedrooms #2, #3, #4 and #5, bathroom #2 garage and front yard are currently off limits. LPA observed all rooms in the home to be inaccessible to children by door safety knobs. There is one pet in the facility that stays in the backyard.



Others:
Per licensee and LPA’s observations, there are no bodies of water. Electrical outlets were not observed to be covered. A Technical Violation was issued for this deficiency. Licensee placed covers in the electrical outlets during the inspection.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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: ARCHILA FAMILY CHILD CARE
FACILITY NUMBER: 364841901
VISIT DATE: 05/19/2023
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LPA discussed the safe sleep regulations with licensee Archila 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.

Two Type B Citations and 1 Technical Violation were issued during today’s inspections. 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 Archila, along with her appeal rights and Notice of Site Visit.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 05/24/2023 10:03 AM - 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: ARCHILA FAMILY CHILD CARE
FACILITY NUMBER: 364841901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in. Licensee's assistant did not complete her Health and Safety Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/26/2023
Plan of Correction
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Licensee will send pictures of Health and Safety Training certificate or confirmation of enrollment in a class and assistant's complete file to LPA Beneroso.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in. There were two children's files missing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/26/2023
Plan of Correction
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Licensee will send pictures of complete children's files to LPA Beneroso by 05/26/2023
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 RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023
LIC809 (FAS) - (06/04)
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