197416130-2-9-2023-12-CC-JDMO-CNVV68-20230209150908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416130
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:09:29 PM

Document Has Been Signed on 02/09/2023 03:09 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:	FIGUEROA FAMILY CHILD CARE		FACILITY NUMBER:	197416130
ADMINISTRATOR:	FIGUEROA, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 341-1327
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	02/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Ana Figueroa		TIME COMPLETED:	03:20 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 02/09/2023, at 11:40 a.m., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at the Figueroa Family Child Care Home to assess the Facility operation of their program, its current physical plant status and its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. LPA Del Mundo met with Licensee, Edith Munoz and stated the reason for the daughter guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: living room, bedroom #1, hallway bathroom and rear yard (outdoor play area). Licensee states the day care hours of operation is 24 hours, Monday thru Friday. Currently living in the home is licensee, licensee's spouse, adult daughter and 2 grandchildren (ages 2, 9 months). Licensee is currently providing transportation to children in care. Physical Plant The facility is a one story house. The home is clean and orderly, with heating and ventilation for safety and comfort, maintains a telephone service, (Licensee was advised that the cell phone shall be charged and available during day care hours) has safe age-appropriate toys, play equipment and materials for children in care to use. At the time of this inspection, there are no fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission. Per Licensee, she provides food (breakfast, snacks, lunch and snacks) for children in care. LPAs 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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 02/09/2023 03:09 PM - It Cannot Be Edited

Created By: Joselito DelMundo On 02/09/2023 at 02:17 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FIGUEROA FAMILY CHILD CARE	FACILITY NUMBER: 197416130
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/02/2023
	Plan of Correction
1 2 3 4	Licensee will provide copies of immunization records to LPA thru email.

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:

Lady King

LICENSING EVALUATOR NAME:

Joselito DelMundo

LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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: FIGUEROA FAMILY CHILD CARE	FACILITY NUMBER: 197416130
	VISIT DATE: 02/09/2023

NARRATIVE

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The home is free from defects or conditions which might endanger a child. The fireplace is located in the living room and is covered with a glass to prevent access by children. It has operational carbon monoxide-smoke detector and fire extinguisher which meet established standards. Poisons, detergents, cleaning compounds are stored in the garage (off-limits) where they are locked and inaccessible to children. Medicines are stored in the master’s bedroom (off-limits). First aid kit box is stored in the upper cabinet adjacent to room #1. Per licensee, there are no firearms in the facility. All children, age and ability permitting, and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted at least once a month, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility. Licensee is aware that smoking is prohibited on the premises of a family child care home.

Currently, there are no infants enrolled in their program. Licensee is aware that there must be one crib or play yard for each infant who is unable to climb out of the crib or play yard. The crib(s) or play yards use by the facility must meet the United States Consumer Product Safety Commission safety standards. Placement of crib(s or play yards shall not hinder entrance or exit to and from the space where infants sleep. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. The mattresses shall be made specifically for the size crib or play yard in which they are placed.

The facility has no body of water on the premises. The outdoor play area (rearyard) is properly fenced and supervised by the licensee. Licensee is advised to repair the tool shed door (with peeled paint) located at the rear yard (outdoor play area).The LPA explained to Licensee how to obtain information from the Community Care Licensing (CCL) website (www.cdss.ca.gov).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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: FIGUEROA FAMILY CHILD CARE	FACILITY NUMBER: 197416130
	VISIT DATE: 02/09/2023

NARRATIVE

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Care and Supervision
Per Licensee, she is present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences does not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she is separated from other children in bedroom #1.

Facility Administration
The licensee have current mandated reporter training certificate. The Licensee has current Pediatric CPR and First Aid training certificate. However, licensee has no proof of immunizations against influenza, pertussis, measles and TB skin test on file. Licensee is advised to take the training on preventive health practices. 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 within 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

Licensee is aware that personnel records should be maintained on Licensee and each assistant (if any) and contain the following information: Licensee and staff full name; A signed and dated copy of the Notice of Employee Rights [LIC 9052]; Driver's license number if the employee is to transport children; Date of employment; Date of birth; Current home address and phone number; Documentation of completion of training on preventative health practices as required by Section 102416(c). All personnel records are maintained at the facility. Any changes to the facility from an area of the family child care home should be reported to the Department.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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: FIGUEROA FAMILY CHILD CARE	FACILITY NUMBER: 197416130
	VISIT DATE: 02/09/2023

NARRATIVE

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Records
Licensee and other adults living in the home have received criminal record clearance. At the time of inspection, there is an emergency information card maintained for the child present in the day care.

Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

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

The Facility is not in compliance per Title 22 regulations with regard to licensee’s immunization records. During today's inspection, LPA Del Mundo observed a deficiency that may hinder the health and safety of the children in care. Type B deficiency is cited during this inspection. An exit Interview was conducted and a discussion of observations and this report was conducted. View points were discussed.

A copy of this Report, Review of Staff Records form (LIC 859) and Notice of Site Visit (LIC 9213), Appeal Rights were provided to Licensee, Ana Figueroa.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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