197416069-3-23-2026-12-CC-CALI-DSFPZD-20260323114521

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416069
Report Date: 03/23/2026
Date Signed: 03/23/2026 11:45:54 AM

Document Has Been Signed on 03/23/2026 11:45 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:	COTTAGE FAMILY CHILD CARE		FACILITY NUMBER:	197416069
ADMINISTRATOR/ DIRECTOR:	COTTAGE,YVONNE&MAZAS,MATT		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 206-9049
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 14	DATE:	03/23/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	Matthew Mazas, Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:00 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 March 23, 2026, Licensing Program Analyst (LPA) Crystal Ali conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was granted entry by the Site Supervisor. Upon entry to the facility, the LPA observed 12 children, 2 infants, and 2 staff providing care and supervision. This is a large capacity licensed home. Site Supervisor states Licensee will be present in 15 minutes. Licensee arrived at 9:15am. Licensee guided the LPA on a tour of the home. Licensee's facility child roster is not current last dated 1/13/2026. Licensee states they will provide copy to LPA by the end of today. LPA issued a technical assistance in regards to LIC 9040 not being current. Total enrollments 36. There are no IMS children. The operational childcare hours are Monday through Sunday, 10:00pm-9:00pm, for 23 hours. Licensee states they do have children enrolled for overnight care. Landline phone number has changed. Licensee provided the new phone number to LPA. LPA will update Licensee records with new phone number. Staffing Ratio and Capacity: This is a two-story family home. There is a living room, dining room, kitchen, three bedrooms, three bathrooms, laundry area, backyard, and converted garage. The off-limits areas are the entire upstairs (three bedrooms and two bathrooms) and kitchen. All off-limit areas are inaccessible due to safety gates (in home). There are no bodies of water on premises. Per Site Supervisor states there is no smoking and no weapons on the premises.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

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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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)

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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 03/23/2026

NARRATIVE

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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 daycare areas are the living room, dining room, laundry room/bathroom, converted garage (approved by the city 12/30/08), and outside play yard areas including side shed for indoor play when the weather is not appropriate for outside play. Licensee stated that the children eat and sleep in the converted garage area. Licensee does provide food for the children (breakfast, morning snack, lunch, afternoon snack, and dinner). Licensee is in the food program. The food program representative visited the daycare last week, no concerns. The children can bring packed lunches. Those lunchboxes that don’t have ice packs are placed in the refrigerator for the children in care. Licensee provides drinks for the children. There are no window cords in the daycare areas. There are no pets on the premises. There are age-appropriate toys and equipment on the premises. In daycare room, LPA observed one trash can with a lid, mats, and two tables for dining and activities, 1 large snack cabinet and 1 refrigerator/freezer. LPA observed filtered water being offered to children.
Napping: Children are provided napping when needed, around 12:30pm-1:30pm. Licensee provides napping materials, mats and blankets. LPA observed mats, cots, and two play pens for infant napping. Napping materials are cleaned at child home. Children take their blankets home to wash weekly. Mats and play pens are wiped down after each use.
Transportation: Site supervisor stated they do provide transportation. They drop off children at home and pick up children from school. LPA verified licensee and site supervisor’s driver license. LPA observed car insurance to not be valid. LPA observed a large vehicle black astro van.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 03/23/2026

NARRATIVE

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Kitchen: Kitchen is off limits. Knives/sharp items and medication were observed in kitchen top middle cabinet market allergies, inaccessible to children with a safety latch. Licensee states that there are no children on medication. Cleaning supplies and chemicals are kept in the top left cabinet inaccessible (cabinets have safety latches on them) and in the cabinets above the laundry machines. Licensee states there are three children with allergies at this time. Allergies are posted on the cabinet in kitchen and in the large daycare room (converted to garage).
Fire Extinguisher: The required fire extinguisher (2A10BC; dated 1/26/26) is reading in green and in located on the wall in large daycare room, on the wall next to door of daycare room, and in dining room on wall near window. LPA observed three fire extinguishers and two first aid kits in the daycare. Smoke and carbon monoxide detectors were found to be in compliance per Fire Marshall Standards. Fire and Disaster drills are conducted at least every six-months, and the last drills were recorded on 3/5/26. Licensee states the fire marshal came to the facility to inspect on 1/26/26. The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible (out of reach and safety latched) to children kept in on the wall next to fire extinguisher #2 and at the front door.
Bathroom: The daycare laundry room/bathroom is located in the hallway across from living room. It has 1 sink, 1 toilet, washer and dryer machine. Bathroom is clean and in good repair. LPA observed a diaper changing station next to the bathroom.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 03/23/2026

NARRATIVE

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Outdoor Space Activity: The outdoor area is the backyard. The back yard is free of broken toys/furniture & equipment, and other sharp items. The first play yard area has a large play equipment with three slides and safety cushion for the ground. There is a shed on the left side of the home that is accessible to children when indoor play is required for the children due to the weather. It has a large cushion flooring for indoor play. This shed can only be entered through the front door which is located outside the home. Licensee states they used the shed last week and plans to update the cooling system. At 11:00am, LPA informed licensing about ensuring indoor temperature is appropriate for indoor play. Inside the shed to the back is a gym that is off limits to the children by way of safety gate. There is a patio shaded area across from the 1^st play yard area; with 4 chairs and two sheds (locked) inaccessible to children. The second play yard area has play kitchen, water tables, and other toys in good condition. This play area is shaded, however, the cover providing the shade is shedding and needs repair. LPA issued a technical violation for the cover to be repaired. The third play yard area is shaded area that has basketball hoops (two) and large table to seat 14 children.
Records/Documentation: LPA reviewed with Licensee the LIC 126, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Licensee was able to provide valid Pediatric CPR/First Aid training. Licensee was able to provide valid Mandated Reporter training. All employee files (3) review are in compliance. Children’s records (4) are complete. Licensee had all the required posted documents: Facility License (LIC 203A, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148).

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 03/23/2026

NARRATIVE

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Criminal Record Clearance - Family Child Care Homes
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.
Safe Sleep - Family Child Care Homes
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.
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/.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 03/23/2026

NARRATIVE

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MyChildCarePlan.org – Family Child Care Homes
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Megan’s Law - 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.

No deficiencies cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Matthew Mazas.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

LIC809 (FAS) - (06/04)

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