<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191231164
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:11:20 PM

Document Has Been Signed on 07/28/2021 12:11 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:PRINGLE FAMILY DAY CAREFACILITY NUMBER:
191231164
ADMINISTRATOR:PRINGLE, ANNIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 361-5014
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
07/28/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Annie PringleTIME COMPLETED:
12:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 07/28/21 LPA Dorsey conducted an unannounced case management annual continuation. LPA Dorsey met with licensee Annie Pringle and observed 3 children in care. On 07/16/21 Licensing Program Analyst (LPA) Justin Dorsey conducted an unannounced annual random inspection. LPA Dorsey was not able to complete the report due to the licensee stating she needed to go to a doctor’s appointment. Below is what LPA Dorsey observed 07/16/21. The LPA met with licensee Annie Pringle who guided the LPA at 12:50 p.m.on a tour of the facility. Upon entry to the facility the LPA observed 2 children in care who are family members to the licensee and live in the home. Per licensee she cares for 1 other child besides her 2 family members.

This is a one story family home. There is a living room, kitchen/dining room, day care area (attached indoor patio), backyard, den, three bedrooms and two restrooms. Main care is provided in the living room and indoor patio attached to the home referred to as the day care. The children use the bathroom in between the living room and the master bedroom. The off-limits areas include the homes three bedrooms, den, one restroom, laundry area and kitchen.

The day care home provides breakfast, morning snack, lunch, and afternoon snack. LPA Dorsey observed the children eating in the dining room area of the kitchen. According to the licensee this is where the children in care eat. Per licensee she does not transport children. The home is operating the childcare Monday thru Friday: 6:00a.m. to 6:00 p.m.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 07/28/2021 12:11 PM - It Cannot Be Edited


Created By: Justin Dorsey On 07/28/2021 at 08:45 AM
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
CCR
102417(g)(8)

1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home (g)(8) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per Licensee she will creat a children's roster for children enrolled and send proof to LPA Dorsey by POC due date 08/06/21.
8
9
10
11
12
13
14
Based on interview and observation LPA Dorsey found that the home does not have a current child roster, which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
Type B
08/16/2021
Section Cited
HSC1596.866(b)

1
2
3
4
5
6
7
1596.866(b) Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per Licensee she will complete the Pediatric First Aid & CPR training and send proof to LPA DOrsey by POC due date 08/16/21
8
9
10
11
12
13
14
Based on interview and observation the licensee did not a a current Pediatric First Aid and CPR certification which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
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:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 07/28/2021 12:11 PM - It Cannot Be Edited


Created By: Justin Dorsey On 07/28/2021 at 09:04 AM
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
HSC
1596.8662(b)(1)

1
2
3
4
5
6
7
(b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...this requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per licensee she will complete the Mandated Reporter Training and send proof to LPA Dorsey by POC due date 08/06/21.
8
9
10
11
12
13
14
Based on interview and observation the licensee has not completed the Mandated Reporter Training in the past 2 years, which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
Type B
08/06/2021
Section Cited
CCR102417(g)(9)(A)(1)

1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home (g)(9)(A)(1) (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months...The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per Licensee she will conduct a disater drill and send a copy of the log to LPA Dorsey by POC due date 08/06/21.
8
9
10
11
12
13
14
Based on interview the home has not conducted a disaster drill in the past 6 months, which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
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:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 07/28/2021 12:11 PM - It Cannot Be Edited


Created By: Justin Dorsey On 07/28/2021 at 09:22 AM
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
CCR
102417(b)

1
2
3
4
5
6
7
102417 Operation of a Family Child Care (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Per Licensee she will clean any unnecessary debris in the indoor patio area and send proof to LPA Dorsey by POC due date 08/06/21.
8
9
10
11
12
13
14
Based on observation the homes indoor patio had unnecessary debris, which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
Type B
08/06/2021
Section Cited
CCR102417(g)

1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child...This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per Licnesee she will send LPA Dorsey a written plan on how she will manage the homes dog when children are in care, including where the dog will be kept by POC due date 08/06/21.
8
9
10
11
12
13
14
Based on observation the homes dog became aggressive with LPA Dorsey during visit, which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
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:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


LIC809 (FAS) - (06/04)
Page: 8 of 8
Document Has Been Signed on 07/28/2021 12:11 PM - It Cannot Be Edited


Created By: Justin Dorsey On 07/28/2021 at 09:34 AM
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
102421(b)

1
2
3
4
5
6
7
102421 Child's Records (b) (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requiremnet is not met as evidenced by:
1
2
3
4
5
6
7
Per licensee she will put together files for the children in care and send proof to LPA Dorsey by POC due date 08/13/21.
8
9
10
11
12
13
14
Based on interview the licensee does not have files for the children in care, which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


LIC809 (FAS) - (06/04)
Page: 7 of 8
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164
VISIT DATE: 07/28/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 homes knives are kept in a cabinet above the stove. At 1:04 pm LPA Dorsey observed that the child latch to the left cabinet door under the sink to be broken. LPA Dorsey observed cleaning supplies accessible (Ajax and carpet cleaner) to children. Per licensee children in care eat in the kitchen/dining area near this cabinet. Per licensee she has agreed to get latch fixed. At 1:17pm LPA Dorsey toured the homes on-limit restroom, LPA Dorsey observed Lysol spray on top of the toilet and lotion under the sink. LPA Dorsey observed the licensee move these two items so that they are inaccessible to children.

The backyard is fenced all around. The outdoor play area was inspected with licensee, on 07/21/21 LPA Dorsey entered the backyard. While LPA was in the homes backyard LPA was cornered by the licensees Rottweiler. The dog became aggressive and was barking and growling at LPA. The licensee had to call for Famliy Member #1 who was able to get the dog away from LPA. Per licensee she forgot that the dog was in the backyard. LPA Dorsey did not observe any other hazards in the backyard. Per licensee children have not been using the backyard because it has not been set-up since the pandemic. LPA Dorsey observed the homes outdoor play equipment in an off-limit corner if the yard.

There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons.

The homes first aid kit was observed. The required fire extinguisher (2A10BC) does not have a service tag and the receipt is too faded to observe a purchase date. Smoke and carbon monoxide detector are in operable condition (tested 1:36 pm). Per Licensee Fire and disaster drills are conducted every six-month. According to the licensee she can not find the documentation to show these drills. LPA Dorsey Licensee's Pediatric CPR and First Aid certificate expired on 04/2021.

LPA Dorsey advised the licensee that her fees are not current. Licensee had the required posted documents: Facility License (LIC 203, Emergency Disaster Plan (LIC 610A). LPA Dorsey observed the licensee to be missing the following required postings: Notice of Parent's Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148)

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164
VISIT DATE: 07/28/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Dorsey found through interview that the Licensee has not taken the Mandated Reporter training.
The LPA found during interview a current child roster and child files were not available.

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 was informed that 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 your analysis of any person who will be visiting regularly or for longer than #1 week.

The applicant was advised of the requirement 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. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

Safe Sleep new upcoming regulations were discussed with Licensee and referred to the CCL web site for additional information and PINS.

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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: PRINGLE FAMILY DAY CARE
FACILITY NUMBER: 191231164
VISIT DATE: 07/28/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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

Child Care Advocates:


To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541

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

An exit interview was conducted, a copy of this Report and a Notice of Site visit was provided to licensee Annie Pringle. Appeal rights were provided and discussed with licensee Pringle.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 6 of 8