364843262-7-6-2022-12-CC-KZIS-CG3SNM-20220706140145

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364843262
Report Date: 07/06/2022
Date Signed: 07/06/2022 02:02:03 PM

Document Has Been Signed on 07/06/2022 02:02 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:	DE LA PAZ FAMILY CHILD CARE		FACILITY NUMBER:	364843262
ADMINISTRATOR:	KARINA DE LA PAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 486-1459
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY:	14	CENSUS: 9	DATE:	07/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee Karina De La Paz		TIME COMPLETED:	02:20 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, Karina De La Paz who guided analyst on a tour of the facility for the One Year Required inspection. This is single story home with three bedrooms, two bathrooms, kitchen, dining area, living room, day care room, laundry room, front/backyard and detached garage. Per Licensee the kitchen, dining area, living room, day care room, hallway bathroom and backyard are utilized for the family child care activities. Per licensee off-limit areas of the home are all three bedrooms, the master bathroom, laundry room, front yard and detached garage. The off limits areas were inaccessible via child safety gates, and key locked door knobs. Upon arrival, LPA observed nine children in care (one infant, five preschool and four school age children) with the Licensee and staff 1 providing supervision. Currently living in the home are the Licensee, Licensee husband, and two minor children ages 11 and 15. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 5am to 11pm. 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. According to Licensee all cleaning products are stored in the locked laundry room. Sharp knives were stored in high kitchen cabinet. At the time of this inspection zero child care children were being administered medications. If medication are needed, the medications are stored in the off limits laundry room. Household medications are stored in the off limits master bedroom. Per recorded documentation Fire/earthquake drills were last completed in July 2022. The fire extinguisher was serviced in February 2022. Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were tested and found to be 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 dining room is the designated area for ill children in the child care. Report continued on page two

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DE LA PAZ FAMILY CHILD CARE	FACILITY NUMBER: 364843262
	VISIT DATE: 07/06/2022

NARRATIVE

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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 is blocked by a glass screen therefore the fire place is inaccessible to the children in care. The home has zero window in the sleep area.

Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. A changing area is in the living room of the home.

Outdoor: The backyard is split level and is completely fenced. The backyard has a grass area and a concrete area. At the time of this inspection there were zero bodies of water on the premises. The outdoor play area was inspected and play equipment was observed to be free of hazards. LPA observed a dramatic play house, a tiny tots slide, and an additional small play structure. LPA reminded the Licensee to regularly monitor the play equipment for potential hazards.

Per Licensee, the family has three dogs who are current on shots per statement of the Licensee. Licensee expressed the dogs do not interact with the child care children.

CPR/First Aid expires 11/06/20231 and mandated reporter training expires on 6/9/2024.

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 ten child files, the Licensees two staff members and one household member files. Based on LPAs record review the staff were missing proof of immunization against measles, pertussis and influenza, therefore a type B citation was issued for regulation 1597.622(a)(1). Refer to LIC 809D. Child files were complete and included all required information.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep.

The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A). Report continued on page three

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DE LA PAZ FAMILY CHILD CARE	FACILITY NUMBER: 364843262
	VISIT DATE: 07/06/2022

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Report continued from page two

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.

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.

Based on LPAs record review there was one type B citation issued today regarding staff files refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Karina De La Paz.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 07/06/2022 02:02 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: DE LA PAZ FAMILY CHILD CARE	FACILITY NUMBER: 364843262
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two staff files. The staff files were missing proof of immunization against measles, pertussis and influenza which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/13/2022
	Plan of Correction
1 2 3 4	Per Licensee, the staff will obtain proof od the immunization's and the information will be added to the staff files.

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 Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC809 (FAS) - (06/04)

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