197416069-1-16-2024-12-CC-JDMO-CZJT8S-20240116133050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416069
Report Date: 01/16/2024
Date Signed: 01/16/2024 01:31:12 PM

Document Has Been Signed on 01/16/2024 01:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	COTTAGE FAMILY CHILD CARE		FACILITY NUMBER:	197416069
ADMINISTRATOR:	COTTAGE, YVONNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 206-9049
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	01/16/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Yvonne Cottage		TIME COMPLETED:	01:30 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 01/16/2024, at 10:15 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Cottage Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee, Yvonne Cottage and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care takes place in the following areas of the home: converted garage (main day care room), living room, hallway bathroom, side, and rear yard. Licensee states the day care hours of operation is less than 23 hours a day, seven days a week. Currently living in the home is just the licensee, licensee’s spouse, and minor child (17). Licensee is currently providing transportation to children in care. Licensee has current California Driver’s License, vehicle registration, and insurance. During this visit, LPA observed nine children present in the facility with three assistants providing care and supervision. Physical Plant: 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 smoke detector and carbon monoxide detector are in operable conditions (checked at 11:16 a.M.). The facility has a fully charge fire extinguisher with a 3-A:40-B:C classification (reading in green, checked at 11:03 A.M.). Licensee stated that she owns no firearms, and no one smoke in the facility. LPA observed poisons, detergents, and cleaning products are stored in the lower cabinets of the kitchen (off limits) where they are locked and inaccessible to children. Knives and other sharp items are stored in the upper cabinets of the kitchen. LPA observed household medications are also stored in the locked upper cabinets of the kitchen. The first aid kit box is mounted on a wall in the living room of the facility where children do not have any access. Licensee stated that zero

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/16/2024

NARRATIVE

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medications are currently being provided for the current children in care. Licensee is providing meals and snacks to children in care.

The facility is a two-story house. All rooms upstairs are off limits, and a metal gate is used to barricade the entrance leading upstairs. There is a fireplace in the facility and is covered with a glass door. There is an additional plyboard that blocks the fireplace from being accessed by children. The home has central heating and air conditioning units.

Based on records review, fire/earthquake drills were last conducted on December 20, 2023, at 10:00 A.M. and is conducted once a month.

LPA observed safe and age-appropriate toys, multicultural dolls, building blocks, magnet tiles, crayons, papers, books, kitchen set toy, arts and crafts, tables, chairs, cubbies, crib, and other learning materials. Licensee provides fourteen sleeping cots for children to use. LPA observed electrical outlets are covered with a plastic plug to prevent access by children in care. The licensee stated that she owns no firearms, and no one smoke in the facility.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. During the inspection, LPA observed a step stool and potty chairs inside the bathroom. LPA did not observed razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.

Currently, the licensee has 26 children enrolled in the facility. Licensee stated that when a child shows signs of illness, he/she is separated from other children in the living room of the facility.

Outdoor: The facility has no body of water on the premises. The outdoor play area has safe age-appropriate toys and play equipment. The outdoor play area has a porch covered with a mesh cloth and has

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/16/2024

NARRATIVE

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age-appropriate toys and play equipment. LPA observed toy house, slides, bicycles, tricycles, and little toy cars. Per licensee, she supervised children while playing outside. Licensee stated that she has two dog pets that are currently upstairs, and they do not interact with the children. Licensee added that the pets will be given as gifts to their adult children.

At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA reviewed five children’s files, licensee, and assistant’s files. Based on records review, children’s files are complete; licensee and assistants have current mandated reporter trainings that were completed on 09/10/23, 10/09/23, 03/27/22, 07,20/22, and 11/20/23; CPR/First Aid trainings that were completed on 03/28/23, 07/07/23, 01/27/22, 07/07/23, and 01/06/2024. Licensee and assistants have proof of immunization against measles, pertussis, and influenza. Licensee and assistants have TB skin test on file.

Licensee and other adults living and working at the facility have received criminal record clearance.

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified.

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 day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/16/2024

NARRATIVE

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Licensee 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 clearance or exemption, prior to 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.

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-and-resources/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.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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-care-licensing/process

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM to 5:00 PM.

The facility is in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo did not observe deficiencies that may hinder the health and safety of the children in care. No deficiencies were cited

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 01/16/2024

NARRATIVE

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during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

Notice of Site Visit: A Notice of Site Visit (LIC 9213 was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A copy of this Report was reviewed, and Appeal Rights were also provided to Licensee, Yvonne Cottage.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC809 (FAS) - (06/04)

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