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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418889
Report Date: 08/07/2025
Date Signed: 08/07/2025 12:09:13 PM

Document Has Been Signed on 08/07/2025 12:09 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GRIJALVA FAMILY CHILD CAREFACILITY NUMBER:
197418889
ADMINISTRATOR/
DIRECTOR:		GRIJALVA, AIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 396-2746
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Aida Grijalva; LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On Thursday, August 7, 2025, Licensing Program Analyst (LPA) Hanna Cha met with licensee Aida Grijalva. 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. LPA and licensee toured the facility. At time of arrival, there were no children in care. Licensee and licensee’s assistant was present at the facility. During the inspection, one preschool-aged child arrived at the facility. The current days and hours of operation are Monday through Friday from 5:00 a.m. to 10:30 p.m.

Physical Plant: This is a one-story family home with a detached garage. There is a living room, dining room, kitchen, three bedrooms, two restrooms, a den, and a back yard. Main care is provided in the den and Room #1 referred to as the child care area.

Indoor/Children’s Area: LPA inspected the indoor/children’s area for safety, cleanliness and good repair. Per LPA observation and licensee statement, there is no fireplace on premises. LPA observed age-appropriate toys and play equipment, a working smoke detector and carbon monoxide detector. LPA observed a 2A10BC Fire Extinguisher, fully green. There is a designated area for the ill children as necessary. Licensee provides children with cots when children are napping. The off-limits areas are bedroom #2 and #3(key locked) and the detached garage (maintained locked). Children utilize the restroom next to room #1 to the right.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2025
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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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: GRIJALVA FAMILY CHILD CARE
FACILITY NUMBER: 197418889
VISIT DATE: 08/07/2025
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Bathroom: LPA observed childcare bathroom to be in safe and operating condition. Toilet and faucet are in good operable condition. LPA reminded licensee to keep shampoos, mouthwash, razors, toothpaste, and other hazardous items inaccessible to children.

Kitchen: LPA inspected the kitchen for safety, sanitation, and good repair. LPA reminded Licensee, 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 participates in the food nutritional program and provides children with breakfast, morning snack, lunch, afternoon snack, and dinner as needed. Per LPA observation, 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. The outdoor play area enclosed. Storage area for equipment and cleaning supplies made inaccessible with a key lock.

Pools/Spa/Bodies of Water: Per licensee and LPA observation, there are no pools/bodies of water on the premises.

Other: First Aid Kit and medication was observed in cabinet, made inaccessible to children. Per Licensee, there is no smoking in the home. Per recorded documentation, Fire/Disaster drill completed 7/22/25. Electrical outlets made inaccessible. There is a working telephone (cell phone). Poisons, and cleaning products made inaccessible to children (stored in off-limits laundry room with key lock). Per licensee, there are no weapons/firearms on the premises.

File Review: LPA reviewed two children files which included all required documents. LPA reviewed Licensee file which included all required documentation. Licensee Pediatric CPR/First Aid expires on 1/25/2027. Licensee Mandated Reporter training expires on 9/4/2025. Assistant Pediatric CPR/FA expires on 1/25/2027. Assistant did not have a current Mandated Reporter training certification on file. LPA informed licensee that all assistants providing care and supervision to children must complete Mandated Reporter training, renewed every 2 years. Per licensee, assistant currently only provides care four-five hours per week. A Technical Violation issued.

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

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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: GRIJALVA FAMILY CHILD CARE
FACILITY NUMBER: 197418889
VISIT DATE: 08/07/2025
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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
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. 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.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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: GRIJALVA FAMILY CHILD CARE
FACILITY NUMBER: 197418889
VISIT DATE: 08/07/2025
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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 22-02CCP. 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 Aida Grijalva confirmed that there are no Registered Sex Offenders residing in the facility.

During this inspection, one Technical Violation issued.

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

Exit interview conducted and report was reviewed with the Licensee Aida Grijalva along with Appeal Rights.

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

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC809 (FAS) - (06/04)
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