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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843262
Report Date: 09/06/2023
Date Signed: 09/06/2023 05:26:33 PM


Document Has Been Signed on 09/06/2023 05:26 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:DE LA PAZ FAMILY CHILD CAREFACILITY NUMBER:
364843262
ADMINISTRATOR:KARINA DE LA PAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 486-1459
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:14CENSUS: 7DATE:
09/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Facility Representative Blanca Rodriguez and Licensee TIME COMPLETED:
05:35 PM
NARRATIVE
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On September 6, 2023, at 01:25 p.m., Licensing Program Analyst (LPA) Kendal Zirbes met with Licensee Karina DeLaPaz and Facility representative Blanca Rodriguez. 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, facility representative Blanca Rodriguez was present with 7 children (one infant, one child enrolled in Pre-K, and five children over age two), Licensee arrived approximately 15 minutes later.
Physical Plant: 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. Currently living in the home are the Licensee, Licensee husband, and two minor children ages 12 and 16. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 5am to 8:00pm although the Licensee is approved for 24 hour care. 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 cabinet in the classroom and under the kitchen sink. Both cabinet were equipped with child safety locks. Sharp knives were stored in high kitchen cabinet. Household medications are stored in the off limits master bedroom. Per recorded documentation Fire/earthquake drills was last completed in September 2023. The fire extinguisher was serviced in February 2023.

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: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
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: DE LA PAZ FAMILY CHILD CARE
FACILITY NUMBER: 364843262
VISIT DATE: 09/06/2023
NARRATIVE
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Report continued from page one
Safe and age appropriate toys, play equipment and materials were present. The home has smoke detectors and carbon monoxide detectors. 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.
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 was observed to be free of hazards.
Per Licensee, the family has two dogs who are current on shots per statement of the Licensee. Licensee expressed the dogs 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. Based on LPA review of the facility roster, the physician name and phone number was missing for all children. In addition, child addresses, parent/guardian names and enrollment date were missing. The facility was issued a technical advisory notice in 2022 regarding the facility roster. A type B citation was issued, refer to LIC 809D.
File Review: LPA reviewed five child files, the Licensees, two staff members and one household member files. Based on LPA record review, and conversation with Licensee, child 1 is four years old and attends transitional kindergarten. C1s file did not contain documentation verifying C1's enrollment and attendance in kindergarten, transitional kindergarten or elementary school. A technical violation was issued.
Based on LPA review and interviews, S1 has not completed the mandated reporter training. Based on LPA review, S1 file did not contain documentation of the required immunizations (TDAP, MMR, and influenza). S1 has been employed since May 2023. Per LPA review of S2 file, S2 CPR/First Aid certificate did not contain information that the training was EMSA approved. A copy of regulation 102416 Personnel Requirements was provided to the Licensee. A technical violation was issued along with two type B citations, refer to LIC 809D. A staff member was on site with current CPR/First Aid. 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: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/06/2023 05:26 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
PALMDALE CHILD CARE, 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: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in one of three staff files. S1 has been employeed since May 2023, and has not completed the mandated reporter training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2023
Plan of Correction
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Per Licensee, S1 will complete the mandated reporter training. A copy of the training certificate will be provided to the Departmnent. Staff will completed the training prior to the first day of employment
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one of three staff files. S1 has been employeed since May 2023, S1s record did not contain documentation of the required immunizations (TDAP, MMR, and influenza), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/13/2023
Plan of Correction
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Per Licensee, immunization records will be added to S1 file. Documenation will be submitted to the Department.
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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8


Document Has Been Signed on 09/06/2023 05:26 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
PALMDALE CHILD CARE, 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: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above when the physician name and phone number was missing for all children. In addition, child addresses, parent/guarian names and enrolmment date were missing. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2023
Plan of Correction
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Per Licensee, the roster will be updated and a copy wil be submitted to the Department.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
LIC809 (FAS) - (06/04)
Page: 4 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: DE LA PAZ FAMILY CHILD CARE
FACILITY NUMBER: 364843262
VISIT DATE: 09/06/2023
NARRATIVE
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Report continued from page two

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

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.

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

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
Page: 7 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: DE LA PAZ FAMILY CHILD CARE
FACILITY NUMBER: 364843262
VISIT DATE: 09/06/2023
NARRATIVE
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Report continued fro 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 three type B citations and technical 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 Karina Del La Paz. .

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

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8