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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
153902778
Report Date:
11/07/2023
Date Signed:
11/07/2023 12:00:24 PM
Document Has Been Signed on
11/07/2023 12:00 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 CHILD CARE
,
39115 TRADE CENTER DR STE. 201
PALMDALE
,
CA
93551
FACILITY NAME:
CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER:
153902778
ADMINISTRATOR:
CHAIRENZA, NANCY
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(661) 256-8155
CITY:
ROSAMOND
STATE:
CA
ZIP CODE:
93560
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
3
DATE:
11/07/2023
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
11:35 AM
MET WITH:
Nancy Chairenza, Licensee
TIME COMPLETED:
12:00 PM
NARRATIVE
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On November 7. 2023, Licensing Program Analyst (LPA), Calloway conducted an Annual Continuation Inspection to capture deficiencies cited during the inspection in the Cares Tool. See 809 D pages.
SUPERVISORS NAME
:
Claretta Yates
LICENSING EVALUATOR NAME
:
Kuliema Calloway
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/07/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/07/2023
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
Document Has Been Signed on
11/07/2023 12:00 PM
- It Cannot Be Edited
Created By:
Kuliema Calloway
On
11/07/2023
at
11:37 AM
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:
CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER:
153902778
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/07/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:
This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation, interview, the licensee did not comply with the section cited above in play structure is in need of repair and cushioning material underneath to prevent injuries which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
12/07/2023
Plan of Correction
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2
3
4
Licensee will provide proof the play structure has been fixed and there is cushioning material underneath for safety by requested POC date of 12/7/23
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:
Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE:
11/07/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/07/2023
LIC809
(FAS) - (06/04)
Page:
2
of
4
Document Has Been Signed on
11/07/2023 12:00 PM
- It Cannot Be Edited
Created By:
Kuliema Calloway
On
11/07/2023
at
11:37 AM
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:
CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER:
153902778
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/07/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in disaster drill logs were not current which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/14/2023
Plan of Correction
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2
3
4
Licensee will provide proof of disaster drill log to Licensing by requested POC date of 11/14/23
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:
Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE:
11/07/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/07/2023
LIC809
(FAS) - (06/04)
Page:
3
of
4
Document Has Been Signed on
11/07/2023 12:00 PM
- It Cannot Be Edited
Created By:
Kuliema Calloway
On
11/07/2023
at
11:37 AM
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:
CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER:
153902778
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/07/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in Licensee did not have current CPR training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/30/2023
Plan of Correction
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2
3
4
Licensee will provide proof of CPR training to Licensing by requested POC requested date of 11/30/23
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(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.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in Licensee did not have current immunizations and spouse (TB test) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/30/2023
Plan of Correction
1
2
3
4
Licensee will provide proof of immunization records to Licensing by requested POC date of 11/30/23
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:
Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE:
11/07/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/07/2023
LIC809
(FAS) - (06/04)
Page:
4
of
4