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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842988
Report Date: 04/06/2023
Date Signed: 04/06/2023 02:19:16 PM


Document Has Been Signed on 04/06/2023 02:19 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:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
364842988
ADMINISTRATOR:JOHNSON, TRASIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 224-6375
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:14CENSUS: 0DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Trasie Johnson, LicenseeTIME COMPLETED:
02:45 PM
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On April 6, 2023, Licensing Program Analyst's (LPA) Kuliema Calloway met with Licensee, who provided access and a tour of the family childcare home for an Annual Random inspection. Upon arrival LPA observed zero children in care. Licensee wants to remain licensed and anticipates having children during the summertime. The home is licensed for 12-14 children and licensee will have an assistant. This is a two story 5-bedroom, 3-bathroom home with kitchen, dining room, family room, living room, laundry room, and garage. There is spa or body of water on the premises. Family members residing in the home include one adult (self) and four minor children there are no other adults living in the home. Incidental Medical Services (IMS) policy were discussed and are not being provided. Licensee is not sure if services will be needed until kids are in care.
Inside: Main childcare is provided in Family Room (next to the kitchen). Children will use the Bathroom #1 (on the left in the hallway upon entry in the front door.) There were shampoos inside the shower, and chemical under the sink and in the medicine cabinet. Licensee is aware they will have to be removed, once kids are in care.
Off limit areas: Downstairs: Living room, Bedroom #1, stairs, garage (key lock), and bonus room will be gated and made inaccessible. Upstairs: Bedroom’s #2, #3, #4 and #5, Bathroom #2 and #3, and laundry room. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kept in kitchen cabinet under the sink and secured with a magnetic lock), medicines are kept in the locked pantry inside a storage container and hazardous items (sharp knives were inside kitchen pantry with a key lock) next to the stove. The kitchen is not gated and made accessible to the children. LPA advised supervision at all times inside the kitchen. LPA observed the locks on the cabinet and pantry. Fire/earthquake drills complete and maintained current utilizing licensee’s own children. The last drill was conducted in April 2023. The Roster was observed but not current since there are no kids in care.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 364842988
VISIT DATE: 04/06/2023
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Physical Plant: The backyard is completely fenced. There is no swing/slide set. There is a jacuzzi (covered and locked). The yard is fenced on the right and a gate on the left. There are chairs and furniture for seating in the yard. The AC Unit and swamp cooler were in the back yard and neither one were covered. LPA recommended covering both units for safety of the children.
Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any in the home. The required fire extinguisher (2A10BC) was inside the home. The smoke detectors are combined with the carbon monoxide detectors and are operable. There is no fireplace inside the home. There is central heating and air. CPR/First Aid expire:1/20/2024. The First Aid kit was observed and is complete. The home is equipped with a sprinkler system built inside the ceiling in all rooms of the home to accommodate safety in the event of a fire.
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, and documenting Disaster Drills (Fire and Earthquake). All food is properly labeled if brought from child’s home; and all food is checked periodically for expiration dates. Applicant was advised how to access forms 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 careLicensing 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:
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 364842988
VISIT DATE: 04/06/2023
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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. 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 web page 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. Each employee and volunteer shall receive anInfluenza vaccination between August 1 and 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: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 364842988
VISIT DATE: 04/06/2023
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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.
Our 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. 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.

Applicant 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”.

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

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

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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