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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147700014
Report Date: 10/08/2024
Date Signed: 10/08/2024 03:18:12 PM

Document Has Been Signed on 10/08/2024 03:18 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:M&MDaycareFACILITY NUMBER:
147700014
ADMINISTRATOR/
DIRECTOR:		Marisol MaciasFACILITY TYPE:
810
ADDRESS:TELEPHONE:
7608761119
CITY:Lone PineSTATE: CAZIP CODE:
93545
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
10/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Marisol Macias, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 10/8/2024, Licensing Program Analyst (LPA) Crystal Ali conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was granted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observe 1 child in care, licensee, her assistant (husband), one adult child, four minor children providing care and supervision (fingerprint cleared for licensee and assistant). Licensee informed LPA that she has three adult children living in the home that are not fingerprinted. Licensee states that they have a live scan appointment on 10/14/24 at 10am. Licensee's facility child roster is not current and needs to be updated. LPA provided licensee the LIC 9040 and live scan forms. There are no IMS children. The operational childcare hours are Monday through Friday from 7:30am-5:30pm.
Staffing Ration and Capacity: This is a one story family home. There is a living room, dining room (daycare area), kitchen (daycare area), sewing/game room, four bedrooms, three bathrooms, and backyard. The off-limits areas are the living room, four bedrooms, two bathrooms, sewing/game room, backyard, front yard. Parent board posted on wall at the entrance of the home. Parent board is in compliance. Licensee had all the required posted documents: Facility License, 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: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: M&MDaycare
FACILITY NUMBER: 147700014
VISIT DATE: 10/08/2024
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Physical Plant: Daycare area is the living room, kitchen and one bathroom (first door on the left). Licensee does not provide food for the children. The children bring their own packed lunches. Lunch boxes are placed in the refrigerator for the children in care. Licensee is not enrolled in the food program. There is a mini refrigerator that holds bottled filter water for all daycare children. Licensee provides filtered bottled water to daycare children. 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 in the daycare area. There are two cats that live outside on the premises they do not interact with the children. Licensee stated both cats are current on their vaccinations. There is a working landline. Licensee prefers to utilize her cell phone which is always charged and kept on her. There are several 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 located in sewing/game room next to the kitchen. If child is ill they will be isolated in daycare area away from other children until there parent arrives. 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. LPA reviewed regulations for large capacity. Licensee stated she is interested in going back to a small facility. Licensee stated there is no smoking on the premises.

Napping: Children are provided napping daily. Licensee provides blankets for older children for napping. Licensee has a play pen and cots (4) for napping. Licensee stated she was not aware of safe sleep regulations. LPA provide licensee the required documentation for safe sleep.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: M&MDaycare
FACILITY NUMBER: 147700014
VISIT DATE: 10/08/2024
NARRATIVE
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Transportation: The licensee does not provide transportation.
Kitchen: Knives are kept in the kitchen in a low drawer next to kitchen sink in front of window. The safety latch on this drawer needs to be replaced. There is a cabinet in the kitchen that has blender blazes and other sharp items that is accessible to children. Licensee stated a safety latch will be placed on the cabinet. LPA observed both cabinets under the kitchen sinks that have chemicals. Licensee stated she will provide safety latches on the cabinets. LPA observed two recycle trash cans in kitchen with no lids.
Medication is kept in the kitchen top locked cabinet near kitchen window near sink inaccessible to children in care. There are no children on medication at this time. Children with no allergies at this time. If a child has allergies, it will be located in the child file.
Fire Extinguisher: The required fire extinguisher (2A10BC) is reading in green and in located on the kitchen wall next to sliding door for backyard (last inspected 9/26/24. Fire alarm and carbon monoxide dual detectors were found to be in compliance. Both tested at 1:35pm on 10/8/24. Fire and Disaster drills are conducted at least every six months. Last drill was completed 10/1/24 at 1pm.
Bathroom: The daycare bathroom is down the hallway first door on the left. It has 1 sink, 1 toilet. Bathroom is clean and in good repair.
Outdoor Space Activity: The front yard and back yard are off-limits. Licensee states that the children are walked in by her or their parent to the front door. Licensee states she will take a five minute walk to park with children for outdoor play.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: M&MDaycare
FACILITY NUMBER: 147700014
VISIT DATE: 10/08/2024
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Records/Documentation: LPA reviewed with facility representative the LIC 126, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Licensee was not able to provide a valid Pediatric CPR/First Aid training and mandated reporter training for her and her assistant. Licensee CPR/FA expires 8/2022 and mandated reporter training expires 8/2022. LPA informed licensee that this does not meet the requirements. The assistant fingerprint is cleared in Guardian. The assistant file is not complete. LPA provided licensee a copy of the LIC 126 to help make the staff files. LPA reviewed one child file that was not in compliance. Child file is missing the admission agreement.
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.
Safe Sleep - Family Child Care Homes
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: M&MDaycare
FACILITY NUMBER: 147700014
VISIT DATE: 10/08/2024
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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.

Deficiencies Cited: (See LIC 809D). The following 1 Type A and 2 Type B’s deficiencies are being cited in accordance with 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, Marisol Marcia’s.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/08/2024 03:18 PM - It Cannot Be Edited


Created By: Crystal Ali On 10/08/2024 at 02:15 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: M&MDaycare
FACILITY NUMBER: 147700014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above by having three adult children living in the home without fingerprint clearances which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2024
Plan of Correction
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Licensee will provide proof of completion to LPA Ali. The daycare will remain closed until all fingerprints have been cleared in guardian.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/08/2024 03:18 PM - It Cannot Be Edited


Created By: Crystal Ali On 10/08/2024 at 02:15 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: M&MDaycare
FACILITY NUMBER: 147700014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024

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
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Based on observation, interview, record review, the licensee did not comply with the section cited above in providing documentation of completion of mandated reporter training for licensee and assistant which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2024
Plan of Correction
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Licensee states that she will provide a proof of completion to LPA Ali.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in providing proof of CPR/FA completion which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2024
Plan of Correction
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Licensee states she will provided proof of completion to LPA Ali.
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: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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