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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908354
Report Date: 01/24/2025
Date Signed: 01/24/2025 02:37:31 PM

Document Has Been Signed on 01/24/2025 02:37 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CARDENAS, AMELIA FAMILY CHILD CAREFACILITY NUMBER:
153908354
ADMINISTRATOR/
DIRECTOR:		CARDENAS, AMELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 822-1038
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/24/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Amelia Cardenas, Licensee TIME VISIT/
INSPECTION COMPLETED:
03:02 PM
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On 01/24/2025, Licensing Program AnalystS (LPAS) Justeene Tamayo and Hanna Cha conducted an unannounced one year required inspection at the Cardenas Family Child Care Home. Upon arrival, the LPA met with licensee who guided LPA on a tour of the facility. Family members residing in the home include 1 adult and no minor children. All adults living in the house have been background cleared. Per the Licensee, hours of operation are Monday through Friday 7:00am – 9pm. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 2 infants and 1 preschool child in care. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a single-story home with 3 bedrooms and 2 bathrooms. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds(in garage with safety door knob), medication and hazardous items (master bedroom with safety door knob) that can pose a danger to children. LPAs observed age-appropriate safe toys and napping equipment on the premises.

Main Care Area: Main care is provided in bedroom#1(sleeping room), living room near front entrance, family room(near kitchen with safety gate). Children use the bathroom located straight down the hallway. LPA observed age-appropriate toys, play equipment, and furniture for the children. There are age-appropriate games and books on the premises. Per licensee, there is a designated area for ill/sick children in the living room. Children nap in the living room. There are no firearms on the premises, and no animals on the premises.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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: CARDENAS, AMELIA FAMILY CHILD CARE
FACILITY NUMBER: 153908354
VISIT DATE: 01/24/2025
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Fireplace: There is an electric fireplace located in the living room. The fireplace is blocked by a couch and is not currently in use.
Children's bathroom: Children use the bathroom located in the hallway. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition.

Kitchen/Dining Room: The kitchen does not have a physical barrier; but contains safety latches. Per licensee, she currently has a food program. Meals offered: Breakfast, AM Snack, Lunch, PM Snack and dinner. Sharp items such as knives are located in the upper cabinet above the refrigerator unreachable to day care children in care.

Backyard/Outdoor areas: The backyard is all fenced in. The outdoor play area was inspected and was observed to be in good condition. LPAs observed play equipment with a slide and swings for the day care children to utilize. There is a storage shed with a master lock. LPAs observed the outdoor air conditioner unit needing a mesh covering. Licensee will purchase a mesh covering for the outdoor air conditioner, and will send proof of completion to LPA Tamayo no later than 01/31/25. There are no pools or bodies of water observed on the premises.

Off-limits: Per licensee, the off-limit areas of the home include bedrooms #2-3, bathroom #2, laundry room(located in garage with safety door knob, and garage(safety door knob).



Care and Supervision: Licensee is within the ratio for a large facility. The Licensee was reminded that supervision is always required for children in care.


Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.
Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPAs observed a required fire extinguisher (2A10BC) reading in Green and currently serviced. The facility currently does not have childcare insurance. Per licensee, she currently does offer transportation, LPA observed insurance to be current.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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: CARDENAS, AMELIA FAMILY CHILD CARE
FACILITY NUMBER: 153908354
VISIT DATE: 01/24/2025
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Incidental Medical Services (IMS): 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 Licensee will not be providing IMS to the children at this time.

Records: Children’s records were observed to be complete. Licensee’s CPR/First Aid is maintained current, it expires on 11/10/2026. Mandated Reporter training is completed and expires 02/05/2026. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 01/02/2025.. Per LPAs observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and LIC9227 (Individual Sleeping Plan) and Sleep Logs. LPAs discussed the safe sleep regulations with licensee Cardenas and discussed the Child Care Licensing Safe Sleep webpage at www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Provider Information Notices (PINs) & Child Care Advocates: You can now sign up for Quarterly Updates on Rules, Regulations, Policies and PINs for one or more programs through our DSS website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe Applicant was informed all forms pertaining to Child Care Licensing can be found at https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Child Care Advocates Program: Provides information and resources about licensed childcare. www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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: CARDENAS, AMELIA FAMILY CHILD CARE
FACILITY NUMBER: 153908354
VISIT DATE: 01/24/2025
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Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Cardenas was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 days of incident to the department. Licensee was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

No deficiencies have been cited at this time.

Exit interview conducted and a copy of this report was reviewed with the licensee Cardenas, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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