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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416069
Report Date: 01/09/2025
Date Signed: 01/09/2025 11:24:46 AM

Document Has Been Signed on 01/09/2025 11:24 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:COTTAGE FAMILY CHILD CAREFACILITY NUMBER:
197416069
ADMINISTRATOR/
DIRECTOR:		COTTAGE, YVONNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 206-9049
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
01/09/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:04 AM
MET WITH:Yvonne CottageTIME VISIT/
INSPECTION COMPLETED:
11:23 AM
NARRATIVE
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On January 9, 2025, at 10:04 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at Cottage Family Child Care. LPA met with the licensee, Yvonne Cottage, and was granted access to the facility. LPA stated the purpose of the inspection to the licensee.

During this visit, LPA observed 13 children present at the facility with two staff providing care and supervision. LPA reviewed one of the assistants’ files. Based on records review, files are complete.

The reason for this visit is to address the absence of the license from the license facility for several days.

Based on the License’s statement, confidential interviews with relevant parties, supporting documents, and LPA observation, it was revealed that the licensee was out of state for personal reasons. Confidential interviews revealed the License was away between October 26, 2024, until November 6, 2024. Licensee allowed the license day care to operate while the licensee was away more than 20% on the above listed dates. This a violation of Title 22, division 12, section 102417(a), Operation of a Family Child Care Home, (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.

A Type B deficiency was cited during this inspection. LPA provided a LIC 855 Declaration Statement to the licensee. Licensee filled it out and gave the copy to the LPA.

A LIC 9213 Notice of Site Visit was left at facility and must be posted for 30 days. Failure to do so will result in an immediate civil penalty assessment of $100.00.

An exit interview was conducted, Appeal Rights and a copy of this report were provided to the licensee, Yvonne Cottage.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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Document Has Been Signed on 01/09/2025 11:24 AM - It Cannot Be Edited


Created By: Joselito DelMundo On 01/09/2025 at 10:46 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: COTTAGE FAMILY CHILD CARE
FACILITY NUMBER: 197416069

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
102417

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102417 Operation of a Family Child Care Home
(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 was not met as evidence by:
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Licensee was made aware that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. LPA provided a LIC 855 Declaration statement stating that the licensee will comply with Title 22, division 12, section 102417(a), Operation of a Family Child Care Home.
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Based on record review and confidential interview, the facility did not comply with the section cited above by failing to report the licensee’s absence from the facility which posed a potential Health, Safety or Personal Rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
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