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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700033
Report Date: 07/22/2026
Date Signed: 07/22/2026 01:03:25 PM

Document Has Been Signed on 07/22/2026 01:03 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: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: 6DATE:
07/22/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Wanda Burgess, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:46 PM
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On Wednesday, July 22, 2026., Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced annual inspection and met with licensee Wanda Burgess who granted access and guided LPA on a tour of the facility. Family members residing in the home have been cleared and associated to facility. LPA observed two(2) infants and two(2)preschool children and two(2) school age children present. A total of six children were observed in care and two staff observed providing care and supervision. LPA observed facility to be within ratio. Operating hours are Monday to Friday from 6:00 am to 8:30 pm. Licensee serves ages zero to 13 years old. Annual fee is current.
This facility is a two-story home that consists of 4 bedrooms, 2 bathrooms, kitchen, living room, dining room, family room (day care room), laundry room, garage, and front and backyard fenced.
Areas off limits to children include- All second floor which includes bedrooms, and two bedrooms. Backyard, laundry room and garage. kitchen, and a section of the backyard. LPA observed a gate barrier below stairs to prevent children access to the second floor,

Areas accessible to children include- living room, kitchen, family room (day care room), dining room, bathroom located in the hallway and front yard

LPA inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA observed a mini split AC/heater in the day care and living room. LPA observed the furniture, and children’s materials to be in good condition and age appropriate. LPA observe a fireplace barricaded with a black fence.

Lady King
Isabel Ortega
DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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This is a two-story single-family home. There is a living room, dining room, kitchen,
four bedrooms, four restrooms, laundry area, attached garage (maintained
locked), a back yard and a family room. Main care is provided in the family room
and room #1 referred to as the Child Care Play area. Room #1 is utilized for
napping and activities for children. Children utilize the restroom in room #1 to the
right of the main entrance of the home. Licensee provides children with mats, for
napping, infants are provided with a crib for napping. The off-limits areas are
bedrooms #2, #3 and #4, three restrooms, laundry area and attached garage
(maintained locked). The area of isolation was inspected and takes place by the
entrance of the day care. LPA observed a black metal childcare safety gate at the
bottom of the stairs.
The First Aid kit with a temperature thermometer was observed. The required fire
extinguisher (2A10BC) is reading in green (blue tag observed dated 9/02/25). Smoke and
carbon monoxide detectors are in operating condition(tested 11:20 am. Fire and disaster drills are
conducted every six months; last drill was conducted and documented on 7/13/2026 at 2:15 p.m.
Licensee had all the required posted documents: Facility License (LIC 203, Notice of
Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake
Preparedness Checklist (LIC 9148).

The licensee and staff maintain proof of immunization against pertussis (TDAP), measles
(MMR), Tuberculous (TB) and influenza.
Licensees provided certificate of completion Pediatric First Aid and CPR training
approved dated 8/03/20204 Pediatric First Aid and CPR does not expire until August
2026.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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Childcare Provider Mandated Reporter training – General, Childcare Provider and Exam
are required to be renewed every two-years. Licensee and staff provided Child Care
Provider Mandated certificate dated on 05/20/2026.
Safe Sleep regulations (under 24 months) were discussed with Licensee and referred to
the CCL web site for additional information and PINS. Infants under 2 years of age shall
have the 15-minute check log completed during nap time. Each infant 0-2 years shall be
checked for breathing, color and position every 15 minutes. LPA observed the Safe
Sleep plan completed by Parent and licensee. LPA also observed the safe sleep logs
completed every 15 minute's while napping and infant position is noted.
The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers
and any other item that falls into that category are permitted in the facility. The LPA also
discussed earthquake safety and necessity of drills, required forms for children’s files,
facility files and posting requirements and penalty.
The licensee is aware all adults living in or having access to the home are required to
have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to
having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up
to $500, per non-cleared adult will be assessed immediately. Please advise the Officer on
Duty of any person who will be visiting regularly or for longer than one week. Must be
associated and fingerprint cleared.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the
department by telephone or fax during the department's normal business hours before the
close of the next working day following the occurrence during the operation of family day
care home. In addition, a written report shall be submitted to the department within seven
days following the occurrence of any events specified above.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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Licensee was informed to utilize the Unusual Incident Report/Injury Report form LIC624B
when submitting the report to the department.

The following was also discussed with the licensee:
1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or
Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations
101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations,
Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Pediatric First Aid and CPR: American Heart Association or American Red Cross or
Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR
must be present. Certification must be renewed every two years.

3. Licensee was informed that the mandated reporter training must be completed every 2
years, and is available at www.mandatedreporterca.com

4. In the absence of the licensee a qualified adult must be present, supervising the
children; a qualified adult is an individual who has a valid and current Pediatric first aid/
CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance
associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or
Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

5. A current roster of children enrolled must be available and maintained for a period of 3
years, even after children are no longer attending the facility.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 5 of 9
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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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6. Annual fees must be paid promptly and by the due date or a late fee shall be assessed
and/or the license shall be evaluated for termination.

7. The fire extinguisher Type 2A-10BC must be serviced or purchased annually or as often as necessary and smoke and carbon monoxide detectors should be checked /replaced every 10 years, and batteries replaced as needed.

8. Changes should be reported to the Department as soon as they occur such as
construction, remodeling, telephone number changes and/or if you move from your home.

9. Any unusual incidents or injuries must be reported to the Department within 24 hours
via telephone and within seven (7) days in writing (refer to LIC 624B).

10. Fire and safety drills must be performed every six (6) months and documented for
review by the Department.
11. Smoking is prohibited in the family childcare home.

12. Children and staff records must be maintained and updated as needed and be
available for review by the Department.

13. Immunization Requirement: H&S 1597.622: 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. The licensee and all adults
working with children have proof of immunization.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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14. Inspection Authority: All adults living and working in the home shall be made of aware
of the Department’s right to inspection the home, which includes, but is not limited to the
right to enter the home when children are being cared for, interview children and adults
and review documentation.

15. The facility license number must be on all advertisements, publications, or
announcements with the intent to attract clients.

16. Isolation for children: When a child is ill, he/she shall be separated from other children
(reference 102417(e) Operation of a Family Childcare Home).

17. Liability Insurance was discussed; LPA informed Licensee to review Title 22
Regulation 102417(m)(1) for additional information.

18. Dog(s) and/or pets are recommended to be isolated from children in care.

19. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any
other item that falls into this category is not permitted in the facility.

To improve the quality and value of the new inspection process, a survey may be sent to
the email address provided. Please complete the survey and share your inspection
experience. If you have any questions regarding the process or CARE tools, please send
email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the
inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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Safe Sleep regulations (under 24 months) were discussed with Licensee and referred to
the CCL web site for additional information and PINS. Infants under 2 years of age shall
have the 15-minute checks logs completed during nap time. All infants under one year of
age shall have the LIC9227 sleep plan completed by parent until infant master’s
developmental stage of rolling over on their own. Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresource
s/safe-sleep as an additional resource.

LPA also informed licensees 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
22-02CCP. 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 Childcare Centers and
the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org-Family Childcare Homes Licensee was informed of the
MyChildCarePlan.org website; a consumer education website that helps families obtain
childcare by connecting them to childcare providers and Resource and Referral Agencies
(R&Rs) throughout California.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: BURGESS FAMILY CHILD CARE
FACILITY NUMBER: 157700033
VISIT DATE: 07/22/2026
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Megan’s Law - Family Childcare Homes During the exit interview, according to
licensee there are no Registered Sex Offenders living in the facility and LPA completed
the RSO profile in FAS.

Childcare Advocates:

To sign up for our Quarterly Updates please email the Childcare Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-154.

The licensee was informed of the responsibility to report suspected Child Abuse by calling
the Child Abuse Hot line at 1-800-540-4000.

The facility is complying with Title 22 regulations no citations were issued today.

An exit interview was conducted, a copy of this Report, a Notice of Site visit and Appeal
rights were provided and discussed.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
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