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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700020
Report Date: 05/17/2024
Date Signed: 05/17/2024 12:51:46 PM

Document Has Been Signed on 05/17/2024 12:51 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:VILLICANA FAMILY CHILD CAREFACILITY NUMBER:
157700020
ADMINISTRATOR/
DIRECTOR:		VILLICANA, RENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 608-7470
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:44 AM
MET WITH:Rene Villicana, Licsenee TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 5/17/2024, 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 9 children in care and 2 staff providing care and supervision (fingerprint cleared and associated to the center). Licensee's facility child roster is current and maintained up to date. There are no IMS children. The operational childcare hours are Monday through Friday from 7am to 4:30pm.
Staffing Ration and Capacity: This is a one-story family home. There is a living room, daycare room, kitchen, three bedrooms, two bathrooms, backyard, laundry area, backyard and attached garage. The off-limits areas are the kitchen, all bedrooms, one bathroom, backyard, laundry area, and garage. The backyard has a in ground pool that meets state regulations.
Physical Plant: Daycare area is the first room on the right next to the front door. Licensee does not provide food for the children. The children bring packed lunches and snacks. Those lunchboxes that don’t have ice packs 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. The window blind cords are inaccessible to children. Each child has there own cubbies for their belongings.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: VILLICANA FAMILY CHILD CARE
FACILITY NUMBER: 157700020
VISIT DATE: 05/17/2024
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There is one dog on premises that does not interact with the children. There is a working landline and cell phone, always charged and kept on staff. 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 the classroom area.
Napping: Children are provided napping and a calming/resting area for children, if needed. Napping materials are wash weekly by the family.
Isolation area is located in the daycare area to the side near the cubbies or the hallway.
Transportation: The licensee does not provide transportation.
Kitchen: Knives are kept in the kitchen in under stove right drawer with safety latch, inaccessible to children in care. Medication is kept in the kitchen in a high cabinet or refrigerator on top self in locked bag, inaccessible to children in care. Cleaning supplies and chemicals are kept in the inaccessible garage and pantry area away from children in care. Children with allergies is written on the child file.
Fire Extinguisher: The required fire extinguisher (2A10BC) is reading in green and in located under the sink in the kitchen. Fire alarm pull system is in place. Smoke and carbon monoxide dual detectors were found to be in compliance. Fire and Disaster drills are conducted at least every six-months, last drills were recorded on 9/2023 for Earthquake/Disaster and Fire Drill. Licensee stated they will complete fire/earthquake drill this month.
Bathroom: The daycare bathroom is in the daycare classroom. 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 front yard. The front yard is free from sharp objects, broken toys/furniture & equipment, and other debris. Per the Licensee, there is no smoking and no weapons on the premises.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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: VILLICANA FAMILY CHILD CARE
FACILITY NUMBER: 157700020
VISIT DATE: 05/17/2024
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Records/Documentation: LPA 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. Licensee was able to provide a valid Pediatric CPR/First Aid training valid until 8/1/2024. Child Care Provider Mandated Reporter Training Certificate has been completed and is current. Licensee file is complete. The assistant file is not complete. The assistant file is missing mandated reporter training, immunizations, and Pediatric CPR/FA training. Children’s Records files are complete. 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).

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: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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: VILLICANA FAMILY CHILD CARE
FACILITY NUMBER: 157700020
VISIT DATE: 05/17/2024
NARRATIVE
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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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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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: VILLICANA FAMILY CHILD CARE
FACILITY NUMBER: 157700020
VISIT DATE: 05/17/2024
NARRATIVE
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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 three Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes. A notice of site visit was given and must remain posted for 30 days. Appeal rights and copy of this report was provided to licensee.

Exit interview conducted and report was reviewed with the licensee Rene Villicana.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2024 12:51 PM - It Cannot Be Edited


Created By: Crystal Ali On 05/17/2024 at 12:19 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: VILLICANA FAMILY CHILD CARE
FACILITY NUMBER: 157700020

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024

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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Based on observation, interview, record review the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Fire drills are not uptodate. Last fire drill was completed 9/2023.
POC Due Date: 05/24/2024
Plan of Correction
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Licsenee will provide proof of completion to LPA Ali via email.

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: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2024 12:51 PM - It Cannot Be Edited


Created By: Crystal Ali On 05/17/2024 at 12:19 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: VILLICANA FAMILY CHILD CARE
FACILITY NUMBER: 157700020

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Assistant file records does not have proof of immunizations including flu vaccination or refusal of flu vaccine.
POC Due Date: 05/31/2024
Plan of Correction
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Licsenee will provide proof of immunizations to LPA Ali via email.
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, and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Assitant file does not have Pediactric CPR/FA.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee will provide proof that the CPR/FA class has been registered for the assistant to take the training. Licensee will then provide copy of proof of completion of the CPR/FA training via email to LPA (pending the registered date, 6/29/24).
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: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


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