364843616-11-16-2023-12-CC-JDMO-CXMSHJ-20231116125337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364843616
Report Date: 11/16/2023
Date Signed: 11/16/2023 12:53:57 PM

Document Has Been Signed on 11/16/2023 12:53 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:	RIVAS FAMILY CHILD CARE		FACILITY NUMBER:	364843616
ADMINISTRATOR:	DELORES RIVAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 328-8477
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	14	CENSUS: 1	DATE:	11/16/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:58 AM
MET WITH:	Delores Rivas		TIME COMPLETED:	12:55 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	On 11/16/2023, at 10:00 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Rivas Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee, Delores Rivas and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: living room, playroom (main day care), dining area, and bathroom #1. Licensee states the day care hours of operation is 23 hours, seven days a week. Currently living in the home is the licensee and one adult (licensee’s spouse, assistant). Licensee is currently providing transportation to children in care. Licensee has a current driver’s license, vehicle registration, and car insurance. During this visit, LPA observed one child present in the facility and one assistant. 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. LPA observed all cleaning products and detergents are stored in the upper locked cabinets of the storage room (off limits) where they are inaccessible to children. Knives and other sharp items are stored in a locked container in the upper shelves of the storage room. Per licensee, household medications are stored in the licensee’s room where children do not have any access. Licensee also told LPA that zero medications are currently being provided for the current children in care. Licensee stated that she is a member of a food program and is providing meals and snacks to children. The facility is a one-story house. There is a fireplace in the living room of the facility and is covered with a

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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 4

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: RIVAS FAMILY CHILD CARE	FACILITY NUMBER: 364843616
	VISIT DATE: 11/16/2023

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
26
27
28
29
30
31
32

Pg 2

mesh screen and the parent’s board. The home has central heating and air conditioning units.
Based on records review, licensee conducted the fire/earthquake drills on November 1, 2023, at 10:30 A.M. and is conducted once a month. However, the fire/earthquake drills were recorded on a piece of note. Licensee was provided a copy of the fire/earthquake drills form. The facility has a fully charge fire extinguisher with a 3-A:40-B:C classification (reading in green, checked at 11:31 A.M.) and the last service date was on July 7, 2023.

LPA observed safe and age-appropriate toys, puzzles, books, building blocks, tables, chairs, arts and crafts, coloring books, and other learning materials. Licensee provides one sleeping twin mattress for a child (7 years old) to use. Licensee stated that the child slept overnight (5:00 P.M. to 6:00 A.M.)

Licensee has first aid kit box stored in the upper shelf of the storage room. The smoke detector and carbon monoxide detector are in operable conditions (checked at 11:36 A.M.). LPA observed electrical outlets are covered with a safety plastic plug to prevent access by children in care. Licensee stated that she owns no firearms, and no one smoke in the facility.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. During the inspection, LPA observed a step stool inside the bathroom. LPA did not observed razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.

Currently, the licensee has 12 children enrolled in the facility. Licensee stated that when a child shows signs of illness, he/she is separated from other children in the living room of the facility.

Outdoor: The facility has no body of water on the premises and the backyard is off limits to children. Licensee stated that she takes children to McDonalds at Maple that has a play land for children to play, and she supervised children while playing outside.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: RIVAS FAMILY CHILD CARE	FACILITY NUMBER: 364843616
	VISIT DATE: 11/16/2023

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
26
27
28
29
30
31
32

Pg 3

At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

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 six children’s files, licensee, and assistant’s files. Based on records review, children’s files are complete; licensee and assistant have current mandated reporter trainings completed on 10/21/2023; CPR/First Aid trainings were completed on 07/22/2022. Licensee and assistant have proof of immunization against measles, pertussis, and influenza. Licensee and assistant have TB skin test on file.

Licensee and other adult working and living at the facility have received criminal record clearance.

The following was discussed with the licensee:

The licensee was reminded that 100% supervision is always required for children in care. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must always have the facility’s phone number; 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

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: RIVAS FAMILY CHILD CARE	FACILITY NUMBER: 364843616
	VISIT DATE: 11/16/2023

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
26
27
28
29
30
31
32

Pg 4

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.

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

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Our Quarterly updates come out every 3 months and are also 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

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

The facility is in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo did not observed deficiencies that may hinder the health and safety of the children in care. No deficiencies were cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

Notice of Site Visit: A Notice of Site Visit (LIC 9213 was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A copy of this Report was reviewed, and Appeal Rights were also provided to Licensee, Delores Rivas.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundo	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4