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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418889
Report Date: 07/01/2026
Date Signed: 07/01/2026 12:59:38 PM

Document Has Been Signed on 07/01/2026 12:59 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:
07/01/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:16 AM
MET WITH:Aida Grijalva: Licensee TIME VISIT/
INSPECTION COMPLETED:
01:12 PM
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On Wednesday, July, 1,2026, Licensing Program Analyst (LPA) Maria Avalos conducted an unannounced annual inspection. LPA met with licensee Aida Grijalva and advised the purpose of the inspection. LPA started the home inspection at 10:24 am Licensee guided LPA on a tour of the facility inside and outside. Operating hours are Monday to Friday from 5:30am to 5:00pm and care for children ages 0-13 years old. LPA did not observed children in care. All adults have received background clearances.

This facility is a one-story family home. There is a living room, dining room, kitchen, three bedrooms, two restrooms, family den and laundry room. Main care is provided in room #1 and family den, both utilized for activities and napping. Licensee utilizes cots for children in care. LPA inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). LPA observed age-appropriate furniture and toys. Household cleaners and poisons were stored in master restroom and laundry room both locked making them inaccessible to children in care. Knives and sharp objects were stored inside kitchen cabinet left from stove with a childproof lock making it inaccessible to children. LPA entered the restroom located next to room #1 and observed the toilet, hand washing sink, hand soap. LPA asked the licensee if there were any pets, poisons, firearms, and weapons. The licensee stated there are no weapons in the home. Licensing has one pet dog Pomeranian he does not interact with children.

The off limit areas are bedroom #2 and #3(key locked), master restroom, laundry room, kitchen area and the detached garage (maintained locked).

Continue on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Maria Avalos
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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: 07/01/2026
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LPA observed the required 2A10BC fire extinguisher located in kitchen and family den, LPA observed they was last serviced on 05/27/26 and needle in fully green area. LPA observed and had the licensee test their carbon monoxide and smoke detectors LPA heard the sound and they are operable. For ill isolation, licensee stated she utilizes a corner of the daycare room #1. LPA observed the last emergency fire drill conducted on 06/22/26 and earthquake drill conducted on 06/22/26.

Licensee stated she provides meals for children. Incidental Medical Services (IMS) were discussed and the licensee confirmed that there is/ there is no children currently require IMS. Licensee stated she currently does not/ has a child with food allergies and on medication.

Outdoor/Children’s Play Area: LPA inspected the outdoor play space for safety, comfort and cleanliness, good repair, age-appropriate toys/equipment, and shady areas. The outdoor play area enclosed, and side gates closed and locked with self-latch. Play areas consist of artificial turf and concrete.

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

File Review: LPA reviewed a sampling of children files which included all required documents. LPA reviewed Licensee file which included all required documentation. Licensee Pediatric CPR/First Aid dated 01/25/25. Licensee Mandated Reporter training expired on 9/4/2025. LPA informed licensee that all assistants providing care and supervision to children must complete Mandated Reporter training, renewed every 2 years. Per licensee, she will complete Mandated Reporter training. A Technical Violation issued for expired Mandated Reporting training and missing immunizations for daughter who sometimes assist her. Licensee will complete training and send proof of training and immunizations to LPA within 10 days.

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.

Continue LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Maria Avalos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: 07/01/2026
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Licensee Aida Grijalva 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.

LPA discussed the safe sleep regulations with licensee Aida Grijalva 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 Aida Grijalva 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 Aida Grijalva 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.

There were no deficiencies cited at this time.

LPA conducted a closing interview with licensee, reviewed the report, provided appeal rights, and a notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with licensee Aida Grijalva.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Maria Avalos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026
LIC809 (FAS) - (06/04)
Page: 6 of 6