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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700007
Report Date: 08/02/2023
Date Signed: 08/02/2023 12:12:54 PM


Document Has Been Signed on 08/02/2023 12:12 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
367700007
ADMINISTRATOR:ADRIANA RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 596-3130
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 8DATE:
08/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Adriana RodriguezTIME COMPLETED:
01:00 PM
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On 08/02/2023 Licensing Program Analyst (LPA) Alemoh, met with licensee, Adriana Rodriguez who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPA observed 8 children (2 infants) in care and 3 adults caring for them. Family members residing in the home include 2 adults (licensee, licensee daughter and 3 minor daughters). Facility hours of operation are Monday - Friday 6AM- 6 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the infant room, and the play room which are separated by a safety gate. LPA observed cribs in the infant area, to be age appropriate, safe and in safe sleep regulations. A play yard was observed for infants to roam around in with safe and age appropriate toys and equipment. In the play room area there are age appropriate toys and equipment for children. Learning materials as well such as books. The children use the bathroom located in the hallway to the left. The off-limits areas are all three bedrooms, second restroom (barricaded by a safety gate) and the kitchen. Laundry room and garage are also off limits and are kept locked during business hours. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept in the garage, and underneath the kitchen sink. Medicines are kept in licensee's bedroom (per licensee there are no day care children currently that are on medications) and hazardous items (sharp knives are kept in the kitchen in the upper cabinet high enough that they are inaccessible to children.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700007
VISIT DATE: 08/02/2023
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Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the living room. Per Licensee, there is a weapon/firearm in the home. Licensee stores the firearm in her bedroom in a safe. The firearm and ammo are both in separate lock boxes. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are not maintained current. Last fire disaster drill was completed on 12/2022. LPA advised licensee to continue to conduct fire drills every six months. Fire drill was observed in the play room area to be barricaded by a safety gate.

Bathroom: LPA observed licensee properly storing two cleaning compounds in a cabinet secured with a safety latch. Toilet and faucet are clean and operable.

Kitchen: Off-limits and barricaded by a safety gate. Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the garage, and underneath the kitchen sink which is locked during business hours. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently does have a food program. Naps are provided on cots the play room.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700007
VISIT DATE: 08/02/2023
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Outdoor: The front yard is off limits. The backyard is completely fenced in with a tall white fence. There is a gate on the right side which separates the dog run. There are one dog in the premises. Per licensee, dogs do not come in contact when children are present. Per licensee the left side of the backyard is off-limits. LPA observed an RV camper parked on the left side of the backyard and was locked. BBQ, and AC unit were observed to be covered and or made inaccessible. LPA observed age appropriate toys, well secured and safe for children.

There is an above ground swimming pool in the backyard. Per licensee she is currently cleaning the pool, and will be putting it away later today when she is done cleaning it. LPA advised licensee to send proof of putting the above ground pool away to LPA later today.

Advisory/Other: First Aid kit was observed with supplies readily available in the infant room. CPR/First Aid expires 06/24. Mandated Reporter expires on 10/23. LPA reminded licensee; mandated reporter training and CPR training must be completed every 2 years.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have child care insurance.

Licensee Adriana 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.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700007
VISIT DATE: 08/02/2023
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LPA discussed the safe sleep regulations with licensee Adriana 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. LPAs 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.

The facility is being cited a Type A deficiency according to the California Code Title 22 Regulations, 101229(a)(1). Licensee adult daughter is residing in the home without fingerprint clearance. This citation poses an immediate health and safety risk. See LIC 809D for deficiencies.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/02/2023 12:12 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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in licensee adult daughter Vanessa returned from school and is residing in the home is not fingerprint cleared which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Licensee will send proof of fingerprint clearance of adult daughter to LPA Alemoh no later than the due date.
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
LIC809 (FAS) - (06/04)
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