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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700119
Report Date: 12/20/2019
Date Signed: 12/20/2019 03:12:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:ROJAS FAMILY CHILD CAREFACILITY NUMBER:
367700119
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/20/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Richelle RojasTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Neal met with applicant, Richelle Rojas today for the purpose of conducting a pre-licensing inspection for a small family child care home. This is a single story home and consists of 4 bedrooms, 2 bathrooms, kitchen/dining area, living room, family room, garage and backyard. Parents will enter child care through front door. Residing in the home are the applicant, her spouse and 3 children. There is no pool or spa on the premises. Incidental Medical Services (IMS) policy was discussed.

Home was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that are inaccessible to children. Fireplace is screened. Child care is to be provided in the living room and family room. Children will use the bathroom to the right in hallway. Laundry room is through a door (key locked & child locked) at the end of the hallway to the left. Garage is accessed through the laundry room and no child care activities will be conducted there. Off limits areas include all bedrooms, garage and the gated portions of the backyard. Kitchen is gated on both sides of entrance. Sharp knives are stored in a plastic bin in a high cabinet. Cleaning compounds and detergents are in the laundry room. All lower cabinets in the kitchen have child locks. Medications are stored in off limits bedroom.

Applicant shall conduct fire/earthquake drills every 6 months and document. A Child Roster form was provided and explained in detail.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ROJAS FAMILY CHILD CARE
FACILITY NUMBER: 367700119
VISIT DATE: 12/20/2019
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Children will play outside in the backyard. There is an artificial grass area for active play. LPA observed toys and play equipment in good condition. LPA observed a trampoline on the premises enclosed by a secure net around it, to prevent accessibility, in the off-limits gated portion of the backyard. Trampoline will not be used by child care children (Declaration obtained). Gated storage area observed with padlock. Licensee has 5 dogs and 1 cat. There is a separately gated dog run on the right side of backyard.
Per applicant, there are no weapons or firearms of any kind in the facility. LPA did not observe any weapons. Applicant has a first aid kit. The required fire extinguisher, carbon monoxide detector and smoke detector are in operable condition. The facility has central AC and heat. Applicant has current Pediatric CPR/First Aid certification, expires 3/2021. Preventative Health and Safety with child nutrition training was completed on 5/18/2019. Mandated Reporter training was completed 5/20/2019. Applicant was reminded that Mandated Reporter training for child care must be completed every 2 years for licensee's and anyone assisting in child care.
The following was discussed with the Applicant:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Roles and responsibilities of being a mandated reporter were reviewed. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Applicant was 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 child care home and in those areas of the family child 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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ROJAS FAMILY CHILD CARE
FACILITY NUMBER: 367700119
VISIT DATE: 12/20/2019
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To email the Child Care Advocates go to: www.childcareadvocatesprogram@cdss.ca.gov

Applicant can review past Quarterly Updates on the Department's website: www.ccld.ca.gov.



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

Requirements for fingerprint clearances and associations were discussed with the applicants. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.

Applicant was 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.

Handout for Safe Sleep Concepts was given to the applicant and discussed. Handouts for Seat Belt Safety, SIDS, Shaken Baby Syndrome were discussed.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: ROJAS FAMILY CHILD CARE
FACILITY NUMBER: 367700119
VISIT DATE: 12/20/2019
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Applicant was advised that Licensees must post the Notice of Site Visit 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 and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

The application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification.

Exit interview was conducted, report was read, and a copy has been given to applicant.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
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