367700040-5-18-2023-12-CC-BBEO-CRXM3J-20230518091512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700040
Report Date: 05/17/2023
Date Signed: 05/18/2023 09:15:40 AM

Document Has Been Signed on 05/18/2023 09:15 AM - 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:	VALDEPENA FAMILY CHILD CARE		FACILITY NUMBER:	367700040
ADMINISTRATOR:	VALDEPENA, GUENDOLYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 865-4201
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY:	14	CENSUS: 7	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Guendolyn Valdepena		TIME COMPLETED:	11:55 AM

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 05/17/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Valdepena Family Child Care Home. Upon arrival, the LPA met with the Licensee, Guendolyn Valdepena, who guided the LPA on a tour of the facility. Family members residing in the home include 3 adults (licensee, spouse, licensee's adult daughter) and 4 minor children. All adults living in the house have been background cleared. Per the Licensee, the hours of operation are Monday through Friday 6:00 AM to 7:00 PM. Per licensee, no overnight care is provided. There are 7 childcare children present. Licensee is within the ratio for a Large facility Incidental Medical Services (IMS) were discussed. Physical Plant: This is a two-story, 5-bedroom, 3-bathroom home with a kitchen, dining area, living room, family room, laundry area, backyard and garage. The garage is off-limits. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows are free of cracks, bugs, and debris. Stairs: All upstairs rooms are off-limits, and the stairs is barricaded with a baby gate to prevent access by children.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: VALDEPENA FAMILY CHILD CARE	FACILITY NUMBER: 367700040
	VISIT DATE: 05/17/2023

NARRATIVE

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Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.
Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit is located in the safety latched closet in the daycare area and was observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. Transportation is currently offered, and proof of insurance was observed. LPA observed a required fire extinguisher (2A10BC) reading in Green and currently serviced.
Fireplace: The fireplace was observed in the living room and is currently not being used. Per licensee, the fireplace is not connected. Per LPA’s observations, there were no hanging window blind cords.
Medications/ Hazardous Materials: Cleaning compounds were observed to be located in the kitchen in a lower cabinet, secured with a safety latch. Medications are kept in the kitchen in an upper cabinet. Per licensee, there are No Firearms at the facility at this time. The facility currently does not have childcare insurance.

Incidental Medical Services (IMS): 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 Licensee will not be providing IMS to the children at this time.

Records: Children’s and infant’s records were observed to be complete and current.
Licensee’s CPR/First Aid is maintained current. It expires on 01/2025. Mandated reporter is also maintained current, it expires on 10/05/2023. Per Licensing Information System, facility annual fees were current. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 02/13/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: VALDEPENA FAMILY CHILD CARE	FACILITY NUMBER: 367700040
	VISIT DATE: 05/17/2023

NARRATIVE

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SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: VALDEPENA FAMILY CHILD CARE	FACILITY NUMBER: 367700040
	VISIT DATE: 05/17/2023

NARRATIVE

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Main Care Area: Main care is provided in the family room and bedroom #1. Children use the bathroom located next to the kitchen. Children eat in the daycare area. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises of this facility. Per licensee, there is a designated area for ill/sick children in bedroom #1.

Children's bathroom: Children use the bathroom located next to the kitchen. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition. Toilet and faucets are clean, safe, and operable.

Kitchen/Dining Room: The kitchen has safety latches in all drawers and cabinets. Sharp knives are inaccessible and kept above the refrigerator.

Backyard/Outdoor areas: The backyard is completely fenced (with wooden fence and cement block). LPA inspected and was observed the backyard to be free of hazards, lose or sharp parts and tools. LPA observed appropriate and safe toys in the play area. Per licensee, there is a pool above ground installed in the summer. LPA inspected the gate and pool designated area. The gate is self-latching, self-closing. The gate is above 5 feet tall. There is a storage shed that remains locked and inaccessible to children.

Off-limits: Off-limit areas include entire second floor (bedrooms 2, 3, 4 and 5) and bathrooms 2 and 3. The second floor is made inaccessible by a safety gate. The garage is made inaccessible to children by a door lock on the door

Others:

Electrical outlets are covered and made inaccessible to children. There are 2 pets in the facility

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara Beneroso	TELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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