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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700033
Report Date: 07/02/2024
Date Signed: 07/03/2024 04:15:25 PM

Document Has Been Signed on 07/03/2024 04:15 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:BURGESS FAMILY CHILD CAREFACILITY NUMBER:
157700033
ADMINISTRATOR/
DIRECTOR:		WANDA BURGESSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 771-7097
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Wanda Burgess TIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On 07/02/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Random 1-Year inspection at the Burgess Family Child Care Home. Upon arrival, the LPA met with the Licensee, Wanda Burgess, who guided the LPA on a tour of the facility. Family members residing in the home include 2 adults (licensee, licensee’s niece). All adults living in the house have been background cleared. Per the Licensee, the hours of operation are Monday through Friday, 6:00AM to 8:30 PM. Per licensee, no overnight care is provided. Upon arrival, LPA observed 3 children in care and two adults providing care and supervision. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a two-story, 4 bedroom, 3-bathroom home with a kitchen, living room, dining area, day care room and backyard. There is a garage that is off limits. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows are free of cracks, bugs, and debris. All electrical outlets are covered.

Stairs: Stairs to second floor of the facility is properly barricaded. The stairs are barricaded by a child safety gate.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/02/2024
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Main Care Area: Main care is provided in the family den referred to as the playroom. Children use the bathroom located on the hallway to the right of the main entrance. Children have access to the playroom and bathroom #1. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises of this facility. Per licensee, there is a designated area for ill/sick children in the family room.

Children's bathroom: Children use the bathroom down the hallway to the right of the main entrance. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition. Toilet and faucets are clean, safe, and operable.

Kitchen/Dining Room: The kitchen does not currently have a physical barrier. Sharp knives are inaccessible and kept above the refrigerator in the kitchen. Per licensee, she is part of a food program. There were no cleaning products accessible to children in the kitchen.



Backyard/Outdoor areas: The outdoor space is completely enclosed and fenced in. Per licensee, she uses the front yard for outdoor play time. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises. There is a play structure well anchored to the ground and in good repair.

Off-limits: Off-limit areas include the second story with all the bedrooms and bathroom #2 and #3, made inaccessible by a child safety gate, The laundry and garage are inaccessible to children by door safety latches. Garage is also made off-limits by a safety door knob.



Others: Per licensee and LPA’s observations, there are no bodies of water. Electrical outlets are covered and made inaccessible to children. There are 4 pets in the facility.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/02/2024
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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 complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (2A10BC) reading in Green and currently serviced.

Fireplace: The fireplace was observed in the living room and is screened with glass and also barricaded by a gate. Per LPA’s observations, there were no hanging window blind cords.
Medications/ Hazardous Materials: Medications are in the off-limits master bedroom, made inaccessible by child safety gate. Cleaning compounds were observed to be located in the laundry room, inaccessible by a safety latch. Per licensee, there are No Firearms at the facility at this time and no one smokes. The facility currently does not have childcare insurance.

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 and current.
Licensee’s CPR/First Aid was not available at the time of inspection. Last CPR observed expired in October 2023 a Type B Violation was issued for this deficiency. Mandated Reported is maintained, it expires on 04/2026.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/02/2024
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Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 04/01/2024. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.
Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP and LIC 9227 (Individual Sleeping Plan). The Licensee was reminded that supervision is always required for children in care. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Burgess 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.

LPA discussed the safe sleep regulations with licensee Burgess and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/02/2024
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Megan’s Law - On this date, 07/02/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

One Type B Deficiency was cited during today's inspection. A notice of site visit was given to licensee and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview conducted and report was reviewed with the licensee Burgess , along with her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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Document Has Been Signed on 07/03/2024 04:15 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 07/02/2024 at 12:40 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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024

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
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Based on observation, interview and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2024
Plan of Correction
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Per licensee, she will send proof of either the CPR Certificate or enrollment for a CPR class no later than 07/16/2024
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:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


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