364844573-5-30-2023-12-CC-KCAY-CSBV5X-20230530160842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364844573
Report Date: 05/30/2023
Date Signed: 05/30/2023 04:08:47 PM

Document Has Been Signed on 05/30/2023 04:08 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:	BROWN FAMILY CHILD CARE		FACILITY NUMBER:	364844573
ADMINISTRATOR:	BROWN, DELANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 881-3291
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92394
CAPACITY:	14	CENSUS: 3	DATE:	05/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:26 PM
MET WITH:	Delana Brown, Licensee		TIME COMPLETED:	04:15 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 May 30, 2023, Licensing Program Analyst (LPA) Kuliema Calloway met with Licensee, who granted access. LPA toured facility with the Licensee for an Annual Random inspection. This is a single story 4-bedroom, 2-bathroom home with kitchen, dining, living room, formal dining room, laundry room and garage. Upon arrival LPA observed 1 school age and two (2) preschool children interacting with licensee. There is no pool/spa or body of water on the premises. Family members residing in the home include 1 adult (licensee) and no children. Incidental Medical Services (IMS) policy was discussed. Operating hours are twenty three hours. Transportation is not provided. Main childcare is provided in the living and formal dining room (at entrance). Children use the bathroom in hallway on the left. Off limit areas include Bedroom #2, #3, Bathroom #2, laundry (key lock) and garage (key lock). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room- locked), medicines (off limits room) and hazardous items (sharp knives in upper cabinet of kitchen) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. There is a landline and cell phone for use. The backyard is completely fenced. Outside has dirt and concrete for play. Age-appropriate bikes and play structures were observed and anchored into the ground.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema Calloway	TELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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: BROWN FAMILY CHILD CARE	FACILITY NUMBER: 364844573
	VISIT DATE: 05/30/2023

NARRATIVE

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Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any weapons in the home. There are age-appropriate toys and napping (cots, playpen) equipment. The required fire extinguisher (2A10BC) and smoke detector and carbon monoxide detectors were tested and are in operable condition. There is no fireplace. Home has central AC and heat. AC Unit in the front of the home (gated). The First Aid kit was observed and is complete. Staff and Child files were reviewed. CPR/First Aid were observed current. Mandated Reporter training is current. Required postings were observed on the wall.

The following 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. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. If food is brought in, it is properly labeled for each child. Licensee shall review food expiration dates periodically. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. 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 Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema Calloway	TELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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: BROWN FAMILY CHILD CARE	FACILITY NUMBER: 364844573
	VISIT DATE: 05/30/2023

NARRATIVE

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State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Requirements for fingerprint clearances and associations were discussed with the licensee. Safe sleep regulations were discussed. Licensee 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 LIC624B. Pamphlet Information regarding SIDS, Seat Belt Safety, Items not permitted by Licensed Family Child Care Home, Maintain required postings.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224) form shall be signed and placed inside the children’s files.

No deficiencies were cited during the inspection.

Exit interview was conducted and a copy of this report was read, and a Notice of Site Visit, were provided to the Delana Brown, Licensee at the facility.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema Calloway	TELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC809 (FAS) - (06/04)

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