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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700145
Report Date: 01/29/2025
Date Signed: 01/29/2025 05:28:08 PM

Document Has Been Signed on 01/29/2025 05:28 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:TRIGUEROS FAMILY CHILD CAREFACILITY NUMBER:
157700145
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/29/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Samatha Trigueros, ApplicantTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 1/29/2025 at 3:00 p.m., Licensing Program Analyst (LPA) Isabel Ortega conducted an announced prelicensing inspection for the purpose of conducting Family Childcare Home pre-licensing inspection for a Small Family Childcare. LPA was greeted by applicant, who guided the LPA on a tour of the facility.

Applicant will operate Monday through Friday: 5:00 a.m – 5:00 p.m. The Applicant will provide breakfast, morning snack, lunch, afternoon snack and dinner as needed. Applicant plans to enroll in a Food Nutrition Program.


This is a one-story family home which consist of four bedrooms, two bathrooms, a kitchen, dining room, living room, laundry room, attached garage and back yard. The living room and dinning room will be the primary location in which care is provided referred to as the child’s play area. Children will utilize the bathroom located to the left from the main entrance of the day care.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TRIGUEROS FAMILY CHILD CARE
FACILITY NUMBER: 157700145
VISIT DATE: 01/29/2025
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The off-limit areas include bedroom #1, #2, #3, and #4, second restroom, laundry room, attached garage (maintained key locked double doors observed). The kitchen is barricade by two white child safety gates. The back yard is enclosed and gated all around. The back yard is divided in two sections the area to the right will be off limits(gate in place). According to applicant there is no pool on the premises and LPA did not observe a pool or bodies of water during inspection. According to Applicant there are no weapons nor guns on the premises, LPA did not observe any guns nor weapons during inspection.

The home was inspected inside and out for safety, comfort, cleanliness, service, heating and center air ventilation. The home has age appropriate toys, play equipment and materials. Applicant stores sharp knives in a kitchen drawer (LPA observed a child safety latch), medication is stored inaccessible to children. Cleaning supplies are stored in the laundry room(key locked).

Applicant has a complete First Aid Kit in the home, which is stored inaccessible to children. A temperature thermometer.

Children will be provided with cots for nap time and the infants will be utilized a pack and play.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TRIGUEROS FAMILY CHILD CARE
FACILITY NUMBER: 157700145
VISIT DATE: 01/29/2025
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Applicant was reminded about ensuring proper care and visual supervision at all times.

LPA observed a fire extinguisher (2A10BC) reading in green and receipt of purchase observed from Costco on 10/16/2024. Applicant tested the smoke detector and carbon monoxide detector. Detectors were found to be in operable condition.



The applicant’s Pediatric CPR/First Aid does not expire until 10/26/2026. The applicant had the required immunization against pertussis (Tdap), measles (MMR), and tuberculosis (TB).
The Child Care Provider Mandated Reporter training was completed on 10/18/2024. Family Child Care Orientation was completed 10/08/2024. The Preventative Health and Safety Training with Lead Prevention was completed on 11/07/2024.

Licensee will have the parent board at the entrance of the day care, visible to parents.

The following was discussed with applicants:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home;
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: TRIGUEROS FAMILY CHILD CARE
FACILITY NUMBER: 157700145
VISIT DATE: 01/29/2025
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Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind in the family child care home.

The Licensee was informed that all adults living in or having access to the home, or employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working 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 your analyst of any person who will be visiting regularly or for longer than one week. The applicant was advised to utilize the Request for Live Scan Service form LIC9163 to have adults fingerprinted and associated to the home.



The Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: TRIGUEROS FAMILY CHILD CARE
FACILITY NUMBER: 157700145
VISIT DATE: 01/29/2025
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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. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports (LIC 9224). If these requirements are not met civil penalties per violation will be assessed.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TRIGUEROS FAMILY CHILD CARE
FACILITY NUMBER: 157700145
VISIT DATE: 01/29/2025
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. This certificate is valid for two years.

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 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 http://www.ada.gov/childqanda.htm


The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TRIGUEROS FAMILY CHILD CARE
FACILITY NUMBER: 157700145
VISIT DATE: 01/29/2025
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Child Care Advocates:
To sign up for our Quarterly Updates and Provider Information Notices (PINs), please subscribe online: http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe

The following was provided to the licensee by via mail. All licensing forms required in children's files; All licensing forms required in the facility; All licensing forms to be posted in the home; Fire and Disaster Drill log; California Car Seat Flyer; Safe Sleep Flyer; Parent Notification Requirements; and Safe Sleep-in Child-Care brochure; and additional resources for the applicant and her Family Child Care Home.



Applicant has met Title 22 regulations and is ready for licensure. A Small Family Child Care Home license with a capacity of 8 children effective 1/29/2025.

An exit interview was conducted, and a copy of this report was provided to applicant All Licensing reports are recommended to be kept on file for minimum three years.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
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