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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414500
Report Date: 07/02/2025
Date Signed: 09/09/2025 11:10:23 AM

Document Has Been Signed on 09/09/2025 11:10 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:AYALA FAMILY CHILD CAREFACILITY NUMBER:
197414500
ADMINISTRATOR/
DIRECTOR:		AYALA, L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 782-6125
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:03 AM
MET WITH:Licensee's Assistant Concepcion GutierrezTIME VISIT/
INSPECTION COMPLETED:
06:40 PM
NARRATIVE
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On 09/09/2025, LPA Hanna Cha amended Facility Evaluation Report dated 07/02/2025 to add correct descriptors and details of Civil Penalty assessed.

On Wednesday , July 2, 2025, Licensing Program Analyst (LPA) Hanna Cha met with Licensee’s Assistant Concepcion Gutierrez. The purpose of the visit was to conduct an unannounced Annual/Random inspection of the facility. LPA disclosed the purpose of the inspection to the Licensee’s Assistant. LPA toured and inspected the facility. LPA observed two assistant’s providing care and supervision to one infant, five preschool children, and one school-aged child at time of inspection. LPA conducted inspection with licensee’s assistant, Concepcion Gutierrez. The current days and hours of operation are Mondays through Fridays, 7:00am-6:00pm.

Upon LPA arrival at the facility, licensee Loreto Ayala was not physically present. Per licensee statement via phone, licensee left the facility three days ago. LPA Cha informed licensee must be physically present at the facility to operate child care. Due to the licensee being absent, LPA Cha informed licensee to immediately contact parents and send all children home. LPA Cha informed licensee that facility cannot operate until licensee returns to the facility. A Type A citation issued for licensee being absent from child care facility for more than 20% of operating hours.

Per LPA interview and record review, Assistant #2 (A2) present at time of arrival, did not have background clearance. Per Assistant #1 (A1) statement, A2 was present at facility for three days. Due to an uncleared adult present at the facility providing care and supervision for three days, a Type A citation issued including a civil penalty of $300. LPA informed licensee that all adults must be fingerprint cleared before being present at the facility and providing care.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2025
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 11
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)
Page: 2 of 11
Document is an Amendment of Original Document on 09/09/2025 10:01 AM


Created By: Hanna Cha On 07/02/2025 at 04:08 PM
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
Page: 3 of 11
Document is an Amendment of Original Document on 09/09/2025 09:45 AM


Created By: Hanna Cha On 07/02/2025 at 04:08 PM
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2025

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
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Based on observation, one tube of toothpaste on sink counter. LPA also observed shampoo, body wash, mouthwash, and other hazardous products in shower stall which poses/posed a potential health, safety or personal rights risk to persons in care.LPA reminded licensee’s assistant to keep shampoos, mouthwash, razors, toothpaste, and other hazardous items inaccessible to children.
POC Due Date: 07/16/2025
Plan of Correction
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Licensee will send proof of photos to LPA Cha via email showing that all hazardous items have been made inaccessible to children.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Child #1 (C1) file missing safe sleep checks. A1 unable to provide safe sleep log indicating documentation since child’s date of enrollment. A Type B citation issued.
POC Due Date: 07/16/2025
Plan of Correction
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Licensee will show proof of safe sleep check documentation for C1 to LPA Cha via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
Page: 4 of 11
Document is an Amendment of Original Document on 09/09/2025 09:49 AM


Created By: Hanna Cha On 07/02/2025 at 04:08 PM
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, A2 missing Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Licensee will send proof of completion of Mandated Reporter training for assistant via email to LPA Cha.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, one of two assistant files missing immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Licensee will send proof of immunizations for assistant via email to LPA Cha.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
Page: 5 of 11
Document is an Amendment of Original Document on 09/09/2025 09:51 AM


Created By: Hanna Cha On 07/02/2025 at 04:08 PM
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review Licensee file and A1 file missing influenza immunization (or declination) for current year which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Licensee will provide proof of influenza immunization or provide written declination for all personnel to LPA Cha via email.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Child #2 (C2) present at time of LPA arrival, did not have a file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Licensee will provide proof of all documentation including immunizations required for child's file to LPA Cha via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
Page: 6 of 11
Document is an Amendment of Original Document on 09/09/2025 08:56 AM


Created By: Hanna Cha On 07/02/2025 at 04:16 PM
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
To request a criminal record exemption, licensee or license applicants must submit information that indicates that the individual meets the requirements of Section 102370.1(c)(2)(D). The Department will notify the licensee or license applicant and the affected individual, in concurrent, separate notices, that the affected individual has a criminal conviction and needs to obtain a criminal record exemption.
(1) The notice to the affected individual shall include a list of the conviction(s) that the Department is aware of at the time the notice is sent that must be addressed in an exemption request.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, Assistant #2 (A2) present at time of inspection, did not have background clearance which poses/posed an immediate potential health, safety or personal rights risk to persons in care. Per Assistant #1 (A1) statement, A2 was present for three days. Civil penalty of $300 assessed. Due to an uncleared adult present at the facility providing care and supervision, a Type A citation issued.
POC Due Date: 07/03/2025
Plan of Correction
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Licensee is aware that uncleared adult cannot be on premises. Upon return from absence, licensee will submit written statement regarding understanding of not having uncleared adults on premises.
Type A
Section Cited
CCR
102417(a)
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, licensee Loreto Ayala was not physically present which poses an immediate health, safety, or personal rights risk to children in care. Per licensee statement via phone, licensee left the facility three days ago. LPA Cha informed licensee must be physically present at the facility to operate child care. LPA Cha informed licensee that facility cannot operate until licensee returns to the facility. A Type A citation issued.
POC Due Date: 07/03/2025
Plan of Correction
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Upon return to facility, licensee to submit documentation to LPA Cha verifying her understanding that she must be present in the home for at least 80% of operating hours.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
Page: 7 of 11
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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500
VISIT DATE: 07/02/2025
NARRATIVE
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Physical Plant: This is a one-story-family home. There is a living room, dining room, kitchen, three bedrooms, two bathrooms, a back yard, detached garage converted to an office space and play room (with permit), laundry room (outside in the play yard) and two sheds in the back yard. The off-limits areas include the master bedroom #3 (child safety knob), laundry room (key locked), two sheds in the back yard utilized for storage (LPA observed one shed locked with a pad lock and the other key locked). Indoor/Children’s Area: LPA inspected the indoor/children’s area for safety, cleanliness and good repair. Per LPA observation, fireplace located in living room area was fully barricaded and screened. LPA observed age-appropriate toys and play equipment, a working smoke and carbon monoxide detector (tested at 12:46pm by LPA Cha). LPA observed a 2A10BC Fire Extinguisher, fully green (serviced May 2025). There is a designated area for the ill children as necessary. Main child care is provided in the detached garage (with permit). LPA observed bedroom #1 (child care room) to include two cribs and one child-sized bed. At time of inspection, LPA observed small lego pieces spread out on mattress of crib. There was no child in crib. LPA informed licensee’s assistant that there should not be loose items in cribs and small items such as lego pieces can become a choking hazard.Bathroom: LPA observed childcare bathroom (down the hall to the right) to be in operating condition. Toilet and faucet were in good operable condition. LPA observed soap available to children. At time of inspection, LPA observed one tube of toothpaste on sink counter. LPA also observed shampoo, body wash, mouthwash, and other hazardous products in shower stall. LPA reminded licensee’s assistant to keep shampoos, mouthwash, razors, toothpaste, and other hazardous items inaccessible to children. A Type B citation issued. Kitchen: LPA inspected the kitchen for safety, sanitation, and good repair. LPA reminded Licensee's assistant, if food is brought from the child’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Licensee currently provides breakfast, lunch, and afternoon snack. Knives and sharp items stored in kitchen cabinets, made inaccessible with child safety locks. Outdoor/Children’s Play Area: LPA inspected the outdoor play space for safety, cleanliness, good repair, age-appropriate toys/equipment, and shady areas. In addition to the play room (detached
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC809 (FAS) - (06/04)
Page: 8 of 11
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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500
VISIT DATE: 07/02/2025
NARRATIVE
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garage with permit) the back yard outdoor space is primarily used for child care depending on the weather. Pools/Spa/Bodies of Water: Per licensee's assistant and LPA observation, there are no pools/bodies of water on the premises. Other: Per A1, there is no smoking in the home. Per recorded documentation, Fire/Disaster drill last completed 6/6/25. Electrical outlets made inaccessible. There is a working telephone. First Aid kit and cleaning compounds stored in high upper shelf, made inaccessible to children. Per A1, there are no weapons/firearms on the premises. Per A1, there are no pets on the premises. File Review: LPA reviewed six children files who were present at time of inspection. Child #2 (C2) who was present at time of arrival, did not have a file. A Type B citation issued. Child #1 (C1) file missing safe sleep checks. A1 unable to provide safe sleep log indicating documentation since child’s date of enrollment. A Type B citation issued.

A2 did not have a file. Two Type B citations issued for missing Mandated Reporter Training and Immunizations for A2.

Licensee file and A1 missing influenza immunization (or declination) for current year. One Type B citation issued.

Facility rosters complete and maintained current. Licensee Pediatric CPR/First Aid expires on 5/18/2027. Licensee Mandated Reporter training expires on 3/29/2027. A1 Pediatric CPR/FA expires on 5/18/2027.

Postings: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), and Fire/Earthquake Drill Log. Documents Provided: Entrance Checklist (Spanish) 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.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC809 (FAS) - (06/04)
Page: 9 of 11
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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500
VISIT DATE: 07/02/2025
NARRATIVE
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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.

Licensee 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.Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations. Also, to enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report (LIC624B) when submitting a report to the department at: www.unusualincidentreport@dss.ca.gov. 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 (7) days following the occurrence of any events specified above.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC809 (FAS) - (06/04)
Page: 10 of 11
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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197414500
VISIT DATE: 07/02/2025
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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 Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
Licensee 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.

During the exit interview, the licensee’s assistant Concepcion Gutierrez confirmed that there are no Registered Sex Offenders residing in the facility.

Two Type A citations and six Type B citations issued at time of inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted, copy of report printed and reviewed with the Licensee's assistant Concepcion Gutierrez along with Appeal Rights.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC809 (FAS) - (06/04)
Page: 11 of 11