367700148-8-11-2020-12-CC-AMAA-BSDRXU-20200811132520

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700148
Report Date: 08/03/2020
Date Signed: 08/11/2020 01:25:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	PATRIZ FAMILY CHILD CARE		FACILITY NUMBER:	367700148
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	08/03/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Veronica Patriz		TIME COMPLETED:	05:06 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	Licensing Program Analyst (LPA) Aaron Mabika, met virtually with Applicant, Veronica Patriz on 08/04/2020 for the purpose of conducting a Pre-Licensing Inspection. Applicant is requesting to provide care and supervision for a Small Family Child Care Home for the capacity of 8 children. Currently residing in the home is applicant, spouse and 3 biological children aged 1, 4 and 14. Per applicant, no other adults reside in the home. Applicant and LPA toured the home virtually indoor and outdoor to ensure the home meets licensing requirements. Applicant is requesting the days Monday through Friday and hours of operation will be 06.30 AM to 06.00 PM. The home is set up as follows: This is a single storey home with 3 bedrooms and 2 bathrooms. Per Applicant the following areas of the home with be utilized for the Family Child Care: Living Room, Bedroom # 2, Hallway Bathroom and the backyard. The off-limits of the home is Bedrooms # 1 and 3, the kitchen, the garage and the storage shed in the backyard. LPA noticed a wood fireplace located in the Living room which was accessible to children and LPA required that it be made inaccessible. The home has central heating and air conditioning. The sharps were observed to located above the tall fridge inaccessible to children while poisons, cleaning detergents were observed to be locked hallway cabinet. More cleaning substance were observed to be locked in a cabinet above the washer, inaccessible to children. Medications and vitamins were observed to be made inaccessible to children with child safety latches in another cabinet with safety latches situated in the hallway.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PATRIZ FAMILY CHILD CARE	FACILITY NUMBER: 367700148
	VISIT DATE: 08/03/2020

NARRATIVE

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Bathrooms were toured and inspected for cleanliness and supplies and sink and toilet are in operable condition. All unused electrical outlets are plugged and made inaccessible to children. LPA observed age appropriate play equipment and toys in the Care Room and backyard and Licensee states that she is expecting a delivery of play sets for her backyard this week. The home is neat, clean and armed with a surveillance system outdoors. Napping equipment in the form of 4 cots were observed stacked in the garage. Per Applicant the children will nap on cots in the Family Room Living room and Childcare room.
The outdoor play area was observed to be free of debris or dangerous conditions. Licensee states she is planning on watering the grass and installing play equipment in the fenced out backyard. The front yard is fenced and gated, and the premises are secured by camera surveillance system. There is a working landline and cell phone. Smoke detectors and carbon monoxide detectors tested operable. There is a fully charged fire extinguisher (2A10BC); and new and fully stocked first aid kit with manual. The water was tested at a safe temperature. Applicant states there are no weapons in the home or on the premises. There is no swimming pool or bodies of water on the premises.
Applicant has current CPR, First Aid Training with the expiration dates of 02/01/2022 and Preventive Health and Safety Training and a stand-alone Lead Poisoning Training Component dated 08/27/2020. Applicant has proof of being immunized against influenza, pertussis and measles and Influenza declination. Applicant has proof of Mandated Reporting Training dated 01/15/2020. Per applicant, transportation will be provided. Applicant has valid California Driver License with expiration date 08/21/2021, valid vehicle register with expiration date 12/26/2020 and valid vehicle insurance with expiration date 01/03/2021. Per applicant all meals and snacks will be provided for children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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

FACILITY NAME: PATRIZ FAMILY CHILD CARE	FACILITY NUMBER: 367700148
	VISIT DATE: 08/03/2020

NARRATIVE

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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. Role and responsibilities of being a mandated reporter. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was supplied with the first packet of forms and advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Safe sleep was discussed and applicant was supplied with Safe Sleep fliers. Applicant was made aware that it is he/she 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 tobacco in a private residence that is licensed as a family child care home and in those areas of the family day 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.
·On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com
**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.
Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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

FACILITY NAME: PATRIZ FAMILY CHILD CARE	FACILITY NUMBER: 367700148
	VISIT DATE: 08/03/2020

NARRATIVE

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Family child care homes shall post during hours of operation. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.
§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year
**Incidental medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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

Applicant advised visit www.shotsforschool.org for Immunization information.
Child Care Advocates: www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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

FACILITY NAME: PATRIZ FAMILY CHILD CARE	FACILITY NUMBER: 367700148
	VISIT DATE: 08/03/2020

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**Applicant was given the pre-licensing application packet with licensing forms included.
**As a result of this inspection, the home does not meet all the provisions of Title 22. Based on this inspection one corrections are required before the License can be generated.

Required correction(s);
1. The wood stove should be barricaded and evidence sent to the Regional Office before August 18, 2020.

Exit interview conducted with Veronica Patriz: A copy of this report and notice of site inspection was discussed and emailed to Tanya King (applicant) with instructions to read, sign and send back to the Regional Office..

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

LIC809 (FAS) - (06/04)

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