<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147700001
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:57:15 PM

Document Has Been Signed on 06/18/2024 02:57 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:Ayala Family Child CareFACILITY NUMBER:
147700001
ADMINISTRATOR/
DIRECTOR:		Mirta AyalaFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4422284055
CITY:BishopSTATE: CAZIP CODE:
93514
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Mirta Ayala, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 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
On 6/18/2024, Licensing Program Analysts (LPAs) Crystal Ali and Carol Heath conducted an unannounced annual random inspection. The LPAs disclosed the purpose of the inspection and was granted entry by the Licensee. The Licensee guided the LPAs on a tour of the home. Upon entry to the facility, the LPAs observe 7 children in care and licensee and husband providing care and supervision (fingerprint cleared and associated to the center). Licensee’s daughter was present to assist in care of the children. Licensee's facility child roster is current and maintained up to date. There is one child that is IMS. LPA Ali explained the importance of IMS for the child in care that has asthma. Licensee will submit an IMS plan to LPA Ali. The operational childcare hours are Monday through Saturday from 4am to 5pm.
Staffing Ration and Capacity: This is a one-story family home. There is a living room (daycare area), dining room (daycare area), kitchen, two bedrooms, one bathroom, and backyard. The off-limits areas are the two bedrooms, hallway closet, laundry closet, furnace door in hallway, and the front yard. In the daycare area there are cubbies for the children belongings can be placed. LPAs reviewed parent board documentation and provided updated documents to the licensee to post. Licensee had all the required posted documents: Facility License (LIC 203A, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: Ayala Family Child Care
FACILITY NUMBER: 147700001
VISIT DATE: 06/18/2024
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
26
27
28
29
30
31
32
Physical Plant: Daycare area is the living room and dining room soon as you enter the home. Licensee does provide morning snacks, lunch and afternoon snacks. The children can bring packed lunches. Lunchboxes are placed in the refrigerator for the children in care. Licensee is not in the food program. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are no window blind cords on the windows. Facility has no pets on premises. Facility has a landline and cell phone both are charged and kept on her. There are age-appropriate toys and equipment on the premises. The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept high in closet up high on self. The children enter facility from the backyard through self-latching gate. The facility is a larger capacity licensee of 14. The facility does not have a fire pull alarm and does not have a single action door handle for the front and back door exits. LPAs informed licensee about the updated requirements for larger facilities.
Napping: Children are provided napping daily. They use mats with their own blankets to lay on the floor for napping. The infants use a smaller mat; however, this doe does not meet the sleep plan requirements. LPAs informed licensee that a crib or play pen need to be use for infant for napping.
Transportation: Do not provide transportation.
Kitchen: Knives are kept in the kitchen in a high cabinet safety latched across from the refrigerator, inaccessible to children in care. Medication is kept in the kitchen in a safety latched high cabinet with knives inaccessible to children in care. Cleaning supplies and chemicals are kept under the kitchen sink with safety latch on it. Children with allergies is written on the child file. Licensee, states that there are no children with allergies.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: Ayala Family Child Care
FACILITY NUMBER: 147700001
VISIT DATE: 06/18/2024
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
26
27
28
29
30
31
32
Fire Extinguisher: The required fire extinguisher (2A10BC) is reading in green and in located on the kitchen wall. Fire alarm and carbon monoxide detectors were found to be in compliance, tested 12:12pm. Fire and Disaster drills are conducted at least every six-months, last drills were recorded on 3/7/24. First aid kit located in the daycare closet near front door. Bathroom: The daycare bathroom down the hallway. It has 1 sink, 1 toilet and 1 shower. Bathroom is clean and in good repair.
Outdoor Space Activity: The outdoor area is in the back yard. The front yard is off limits. The back yard is free of broken toys/furniture & equipment, and other debris. There are one water play tables. Licensee stated that she cleans the table daily and refills them with water. There is a shade area due to multiple trees in the backyard. There are two off limit areas area in the backyard. Per the Licensee, there is no smoking and no weapons on the premises.
Records/Documentation: LPAs reviewed with facility representative the LIC 311A, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. The assistant file (husband) is not complete. The assistant file is missing mandated reporter training. Children’s Records files are complete. However, Sleep logs are not completed correctly. LPA Ali explained how to complete the sleep logs. Licensee said she understood and will begin today writing it correctly.
Criminal Record Clearance - Family Child Care Homes
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: Ayala Family Child Care
FACILITY NUMBER: 147700001
VISIT DATE: 06/18/2024
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
26
27
28
29
30
31
32
Safe Sleep - Family Child Care Homes
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org – Family Child Care Homes
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Megan’s Law - Family Child Care Homes
During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 06/18/2024 02:57 PM - It Cannot Be Edited


Created By: Crystal Ali On 06/18/2024 at 02:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: Ayala Family Child Care
FACILITY NUMBER: 147700001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Assistant does not hav mandated reporter training.
POC Due Date: 06/21/2024
Plan of Correction
1
2
3
4
Licensee will submit proof of completion of assistant mandated reporter training via email to LPA Ali.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Claretta Yates
LICENSING EVALUATOR NAME:Crystal Ali
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: Ayala Family Child Care
FACILITY NUMBER: 147700001
VISIT DATE: 06/18/2024
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
26
27
28
29
30
31
32
Deficiencies cited: (see LIC809D). The following Type B deficiency are being cited in accordance to title 22 of the California code of regulations and/or health & Safety codes.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Mirta Ayala.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 8 of 8