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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401107
Report Date: 04/05/2023
Date Signed: 04/06/2023 08:18:10 AM

Document Has Been Signed on 04/06/2023 08:18 AM - 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:MANZANO FAMILY DAY CAREFACILITY NUMBER:
197401107
ADMINISTRATOR:MANZANO, MARIVELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 349-6242
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Marivel ManzanoTIME COMPLETED:
11:15 AM
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On 4/5/2022, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1 Year inspection at the Manzano Family Child Care. Upon arrival, the LPA met with the licensee, Marivel Manzano who guided the LPA on a tour of the facility. Family members residing in the home include 5 adults (licensee, spouse, mother, adult son, daughter in law) and 2 children (granddaughter: 11 and 6 years old). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Sunday 7:00 a.m. to 6:30 p.m. There were 0 daycare children and her husband present during this inspection. Incidental Medial Services (IMS) were discussed. Pre licensee, she does not provide Incidental Medial Services at this time.
The Home is set up as follows:
This is a single-story home with 4 bedroom, 3 bathroom home with kitchen/dining room, living room, laundry room, and garage. The garage is used for storage only and no childcare activities are conducted there. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.
Main Area: Main care is provided in the living and family rooms. Children use the bathroom located in the hallway on the left. Children have access to the kitchen/dining room and backyard.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/05/2023
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Living room/Family room: LPA observed age-appropriate toys and furniture for the children. A small play kitchen was located in the area, so children can play. There are games and books on the premises of this facility. Pre licensee, there is a fireplace in the area.
Children Bathroom (#1): Children use bathroom #1 on the left side of the entrance. The Bathroom was toured, and inspected sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet and drawers. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair. LPA reminded the licensee to keep toothbrushes inaccessible to the childcare children.
Kitchen: Children have access to the kitchen area. Knives are kept in the Pantry. The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children. LPA reminded to the licensee, all sharp utensils, poisons, and medications need to make them inaccessible to children with child safety latches on cabinet doors and drawers.
Backyard (Declaration): Children will play in the site yard. There is a concrete area for active play. There are no swings or slides. The rear backyard is off-limits to children in care.
Off-limit: Off-limit areas include the home's all 4 bedrooms (key lock), Bathroom #2 and #3, laundry (child safety knob), rear backyard, and the garage. Bedrooms (#1, #2, #3, and #4): LPA observed the key lock to make the room inaccessible to the children.Bathrooms #2 and #3: LPA observed the key lock

The garage can be accessed through a door in the kitchen. It is used for storage and laundry only.


Rear Backyard: 2 dogs stay in the rear backyard (gated). LPA observed 2 small dogs in the area.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/05/2023
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Others:
AC/Heating Unit was observed. AC/Heating Unit is located on the top of the home and is inaccessible to children.
Bodies of water: Per the licensee, there are No bodies of water in the home.
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (2A10BC) fully charged and located in the kitchen inaccessible to children. It meets standards established by the State Fire Marshall.
Fireplace: Fireplace is located in the family room with properly screened.
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 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.
Isolation area (Illness): Per licensee, if the child shows signs of illness, he/she will be separated from other children and stay in Living room.
Medications and cleaning solutions: Medications are kept in the off-limits master bedroom. Cleaning compounds and detergents are kept under the child-locked, off-limits kitchen under the sink and garage.
Napping: Children nap in playpens, 2 mats, and toddler beds. According to the licensee, no children are napping.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/05/2023
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Phone service: There is a working landline or cell phone
Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
The First Aid: No First Aid. The licensee was unable to find the first aid kit
Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license, valid vehicle insurance vehicle registration.
Weapons or Firearms: Per licensee, there are no firearms at the facility at this time.

Documentation:


Child files: LPA reviewed 7 children's records; the records are complete.
CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (1/2024) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
Facility Roster: LPA observed Child Care, Facility Roster. Per Licensing Information System, facility annual fees were current.
Fire Drill and Disaster Drill: Per the licensee, she was unable to find the log.
Immunization: The licensee has the required immunizations. The licensee provided a written statement declining the influenza vaccination.
Infant Sleeping Plan (LIC 9227): LPA shared the information with the licensee. Per Licensee, she will enroll a 4 months infant next month.
Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The licensee was unable to find the facility roster.
Mandated Reporter Training: The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 7/26/23
Staff Personnel File: There is an assistant. However, the licensee does not have her file on site. LPA remined the licensee to create a file for the assistant.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/05/2023
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The following information was discussed with the licensee:
üMandatory Forms for the children's files and provider's files.
üThe licensee is reminded that 100% supervision is required for children at all times.
üCapacity requirements, Roster requirements, and Documentation requirements for disaster drills (fire and earthquake).
üLicensee was made aware that it is their responsibility to know the regulations and anyone who assists in providing care. Licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
üLicensee was advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
üThe licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
üCriminal Record Statement: Licensee [or facility representative] 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 support or exemption prior to the 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.
üSafe Sleep: LPA discussed the safe sleep regulations with the licensee [or facility representative] 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 the licensee [facility representative] 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: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107
VISIT DATE: 04/05/2023
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üA baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
üNotice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
üPosting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
üThe regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban).
üLicensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations.
nOur Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

üThe Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.



An exit interview was conducted, and the report was reviewed with the licensee Marivel Manzano

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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Document Has Been Signed on 04/06/2023 08:18 AM - It Cannot Be Edited


Created By: Carol Heath On 04/05/2023 at 10:22 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: MANZANO FAMILY DAY CARE
FACILITY NUMBER: 197401107

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
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.

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. LPA was unable to observe the fire drill and earthquake drill, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2023
Plan of Correction
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The licensee will practic with childcare children and email to the LPA
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) 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:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The licensee was unable to find rost, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
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The licensee will fill out the new roster and email to LPA.
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:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023


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