367700024-10-31-2022-12-CC-DMAX-CKQRWY-20221031132357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700024
Report Date: 10/31/2022
Date Signed: 10/31/2022 01:24:13 PM

Document Has Been Signed on 10/31/2022 01:24 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:	WHITE, IDA FAMILY CHILD CARE		FACILITY NUMBER:	367700024
ADMINISTRATOR:	WHITE, IDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 701-6591
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	14	CENSUS: 5	DATE:	10/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Ida White, Licensee		TIME COMPLETED:	01:35 PM

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Licensing Program Analyst (LPA) Maddox conducted an unannounced inspection and met with Ida White, Licensee, who guided LPA on a tour of the home. This is a two story home with 4 bedrooms, 3 bathrooms, kitchen/dining area, living room, family room, and garage. There is no pool/or body of water on the premises. The living room; dining area; backyard; and 1 bathroom and bedroom downstairs are designated for child care. All adults in the home (Licensee, husband, and adult son) have fingerprint clearances and exams for T.B, Licensee has the required Immunization's. The average days and hours of operation are Mon - Fri from 6:00 am go 6:30 pm (Licensee states occasionally a child may arrive prior to 6:00 am).

The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devise are in operable condition. LPA reminded Licensee to maintain a current Roster and document Emergency Disaster drills no less than twice a year.

Physical Plant: The fireplace is inaccessible, age appropriate toys and play equipment were observed and available for children, LPA verified there is a functional smoke detector and carbon monoxide detector, fully charged fire extinguisher. Stairs are inaccessible to children under the age 5 via chid protective gate.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WHITE, IDA FAMILY CHILD CARE	FACILITY NUMBER: 367700024
	VISIT DATE: 10/31/2022

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There is a designated area for ill child(ren) as necessary, there are no weapons/firearms, off-limit areas are identified as the entire upstairs area, there is a working telephone on the premises. A baby walker shall not be allowed on the premises of the family child care home. LPA did not observe any unauthorized equipment (i.e. baby walkers or bouncers).

Kitchen: The Kitchen is toured and all all sharp items (knives), medication cleaning solutions, and any harmful chemicals are inaccessible to children via child proof locks or located in upper cabinets.

Bathroom: All hazardous items (such as Medications, air freshener, razor blades, soap, mouthwash, shampoo, razor, nail polish) were inaccessible to children. Toilets and faucets are clean, safe and operable. Bathtub and shower are free of hazards.

Outdoor: The yard is safe for children (inaccessible – lawn mower, gardening tools, poisonous plants, thorn trees, cactus, pets). There is a covered patio section for children to play. The area of the backyard used for child care is fenced with wrought iron fencing. This play area is clear and clean of debris. There are age appropriate toys on available.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 6/14/2024. All unused electrical outlets are covered. There's 1 pet (small Yokie) that is fully vaccinated. Windows are free from cracks, bugs and debris. There are no hanging window blinds cords accessible to children.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WHITE, IDA FAMILY CHILD CARE	FACILITY NUMBER: 367700024
	VISIT DATE: 10/31/2022

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Documents Provided and or Discussed: The following were observed/discussed and or provided: Updated Safe Sleep Regulations including documenting 15 min checks for sleeping infants and form LIC 9227 - Individual Infant Sleeping Plan and the new Lead poisoning Training (Lead Flyer provided).

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/Applicant:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; The requirement to provide adequate supervision to children in care; The 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; Regulation prohibits the smoking of any kind during the operation of the day care.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WHITE, IDA FAMILY CHILD CARE	FACILITY NUMBER: 367700024
	VISIT DATE: 10/31/2022

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Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed change. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care shall be reported to Community Care Licensing.

Exit interview conducted, copy of this report was read and provided to Licensee Ida White on this date.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC809 (FAS) - (06/04)

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