197413061-10-8-2024-12-CC-CHEH-D9UP3U-20241008105807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197413061
Report Date: 10/08/2024
Date Signed: 10/08/2024 10:58:38 AM

Document Has Been Signed on 10/08/2024 10:58 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:	DE LEUW FAMILY CHILD CARE		FACILITY NUMBER:	197413061
ADMINISTRATOR/ DIRECTOR:	DE LEUW, TAMMY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 722-0370
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	10/08/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:24 AM
MET WITH:	Licensee/Tammy De Leuw		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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 10/8/2024, 2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced annual/random inspection at De Leuw Family Child Care. Upon arrival, LPA met with the licensee, Tammy De Leuw, who provided a tour of the facility. The household consists of 3 adults, including the licensee and her adult children. According to the Guardian system, all adults residing at the facility have obtained criminal record clearances. This is a large family childcare facility operating Monday through Friday from 6:30 a.m. to 5:30 p.m. During the inspection, LPA observed 10 children in care (1 5 years old, 4 preschool-age,3 toddlers and 2 infants) under the supervision of the licensee and her assistant (Daughter). According to the Licensing Information System, the facility’s annual fees are current. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children currently require IMS. The home is a two-story house with four bedrooms, three bathrooms, a kitchen/dining area, living room, family room, laundry room, and garage. No pool, spa, or other body of water is present. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service. It has central heating and air conditioning, and all windows have intact screens free of cracks or debris.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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Main Area: Daycare is primarily provided in the converted playroom adjacent to the laundry room. Children use the bathroom in the hallway to the left. They have access to the playroom, living room, and family room. Off-limit areas include all bedrooms, the entire upstairs (secured by a safety gate), bathrooms #2 and #3 (located upstairs), the laundry room (barricaded by a safety gate), and the garage (locked). LPA observed that the main daycare area is fully barricaded with a safety gate. LPA reminded the licensee that safety gates should be installed at the bottom and top of the staircase when children under 5 years old are in care.
Playroom: The playroom has age-appropriate toys, books, games, and napping mats. LPA observed that all materials, including carpets and furniture, were in good condition. Hygienic diaper-changing equipment was also present.
Children’s Bathroom: Children use the bathroom down the hall to the left. The bathroom was inspected and found clean, sanitized, and in good repair. The toilet and sink were operable, clean, and safe, and there were no hazardous items in the bathroom.
Kitchen/Dining Area: The kitchen is off-limits to children during daycare hours.
Backyard: The backyard is fully fenced with cement block walls and is used for outdoor play. It was inspected and found to be safe for children. LPA observed a BBQ grill with Propane, outdoor pizza oven with propane, spa with cover (locked). LPA also observed a outdoor storage needs a lock to make it inaccessible to the children. The licensee was reminded to secure these areas for safety.
Others:
AC/Heating Unit: Located on the right side of the home, blocked by barrels and inaccessible to children.
Bodies of Water: The home has a spa/hot tub with a cover strong enough to support an adult's weight, which is locked when not in use.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 2 of 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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Electrical Outlets: All unused outlets are covered and inaccessible to children.
Fire Extinguisher: A 2A10BC-rated extinguisher is located in the childcare area, reading in the green zone and inaccessible to children.
Fireplace: The living room fireplace is screened and inaccessible to children.
Window Blind Cords: Kept out of children's reach.
Illness Isolation Area: Children showing illness symptoms will be isolated in a designated area.
Medications/Cleaning Solutions: Stored securely in off-limits areas.
Napping: Children nap with supervision; 10 mats are available.
Overnight Care: Not provided.
Pets: 3 vaccinated dogs are kept in an outdoor area during daycare hours.
Phone Service: A working landline or cell phone is available.
Smoke/Carbon Monoxide Detectors: Both are operational.
First Aid Kit: Stored in with complete supplies.
Transportation: Not provided; licensee holds valid driving credentials.
Weapons: No firearms are present in the facility.
Documentation:
Children's Files: LPA reviewed 5 children's records and the records were incomplete and missing some forms. 3 children are missing immunization record. The licensee had to text the parents to email during the inspection. 1 child (enrolled 2 days ago 10/6/2024, does not have any documentation).
Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed that for the 2 infants enrolled, LIC 9227 forms and sleeping logs are NOT present in each infant’s file, and the licensee is not following the Safe Sleep Regulation. According to the licensee, she forgot to fill out the plans and the logs

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 3 of 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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Staff Personnel File: LPA reviewed one assistant file (Daughter) and immunization records, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates.
Immunizations: Both the licensee and her assistant have the necessary immunizations (MMR and DTaP) and have provided a written statement declining the influenza vaccination.
Criminal Record: According to the Guardian system, all adults residing at the facility have obtained criminal record clearances.
CPR/First Aid: LPA observed that the licensee has a current Pediatric CPR and First Aid certification, expiring in January 2025, along with 1 hour of nutrition training and 8 hours of Preventive Health and Safety Training.
Mandated Reporter Training: The licensee completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 2/2/2023.
Facility Fees: The Licensing Information System confirms that the facility's annual fees are up to date.
Fire and Disaster Drills: The licensee conducts fire and disaster drills every 6 months, with the last drill documented on 9/4/2024.
Posting of Required Documents: LPA observed that the licensee has posted the Facility License, Emergency Disaster Plan, Earthquake Preparedness, and Parents' Rights Poster as required.
The following information was discussed with the licensee:
o A 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 4 of 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The 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.
o Mandatory Forms for the children's files and provider's files.
o Our 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
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 5 of 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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o The licensee is reminded that 100% supervision is required for children at all times.
o The 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).
o The 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 childcare home where children are present (24/7 ban).
ü LPA discussed the safe sleep regulations with 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 licensee [or 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.
ü Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 6 of 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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ü IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/
ü IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
ü Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
ü Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
ü Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 7 of 13

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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
	VISIT DATE: 10/08/2024

NARRATIVE

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ü 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-carelicensing/ inspection-process.

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/or Health & Safety codes.

An exit interview was conducted, and the report was reviewed with the licensee, Tammy De Leuw.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 8 of 13

Document Has Been Signed on 10/08/2024 10:58 AM - It Cannot Be Edited

Created By: Carol Heath On 10/08/2024 at 10:20 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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. LPA observed a BBQ grill with Propane, outdoor pizza oven with propane. LPA also observed a outdoor storage needs a lock, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/08/2024
	Plan of Correction
1 2 3 4	The licensee asked her son to remove all the propane and BBQ grill.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. LPA reviewed 5 children's files and 3 children does not have IZ records in the file. The licensee had to text the parents to text the IZ record. The licensee stated she is updating children's files. However, she was unable to provide the old IZ record. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/15/2024
	Plan of Correction
1 2 3 4	The licensee will text all the parents to provide the immunization record and email to LPA by 10/15/2024.

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: 10/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 9 of 13

Document Has Been Signed on 10/08/2024 10:58 AM - It Cannot Be Edited

Created By: Carol Heath On 10/08/2024 at 10:20 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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. A child was in the facility and did not have any enroll today. According to the licensee, the family was enrolled in the past and came back afther mother had new babe. The licensee was unable to find the folder, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/15/2024
	Plan of Correction
1 2 3 4	The licensee will ask parents to fill out another enroll package and submit to the LPA by 10/15/2024 for review.

Type B

Section Cited

CCR

102425(c)(2)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not have LIC 9227 in infants files, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/15/2024
	Plan of Correction
1 2 3 4	The licensee will ask parents to fill out LIC 9227 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: 10/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 10 of 13

Document Has Been Signed on 10/08/2024 10:58 AM - It Cannot Be Edited

Created By: Carol Heath On 10/08/2024 at 10:20 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: DE LEUW FAMILY CHILD CARE	FACILITY NUMBER: 197413061
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. During today's inspection, the licensee was unable to provide 2 infants' sleeping logs, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/15/2024
	Plan of Correction
1 2 3 4	The licensee will complete the sleeping logs for 2 infants and email to LPA on 10/15/2024

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 10/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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