197419004-4-27-2023-12-CC-JDMO-CR9SKP-20230426135701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419004
Report Date: 04/26/2023
Date Signed: 04/27/2023 10:17:18 AM

Document Has Been Signed on 04/27/2023 10:17 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:	HARRY FAMILY CHILD CARE		FACILITY NUMBER:	197419004
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	04/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Shamika A. Harry		TIME COMPLETED:	02:00 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 04/26/2023, at 9:45 a.m., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Harry Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee, Shamika A. Harry and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee 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, bathroom #1 and bedroom #1. Licensee states the day care hours of operation is Monday to Friday from 9:00 a.m. to 5:00 p.m. Currently living in the home is licensee, licensee’s spouse, and one son (10). Licensee is not providing transportation to children in care. During this visit, LPA observed six child presents in the facility. 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. All cleaning products and detergents are stored in the laundry room at the back of the house where they are locked and inaccessible to children. Licensee stated that she only kept butter knives inside the kitchen (off limits) drawer where they are inaccessible to children. There is metal fence barricading the living room and the kitchen Per licensee, household medications are stored in the cabinet of the painting room (off limits) of the licensee. Per licensee, zero medications are currently being provided or stored for the current children in care. Licensee has two boxes of first aid kits which are located underneath the hallway closet. The facility is a one-story house. The fireplace is in the family room (off limits) and a television blocked the fireplace. The home has central heating and air conditioning units.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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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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: HARRY FAMILY CHILD CARE	FACILITY NUMBER: 197419004
	VISIT DATE: 04/26/2023

NARRATIVE

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Fire/earthquake drills were completed last December 2, 2022, and are conducted once every six months. The facility has a new fire extinguisher with a 2-A:10-BC classification which was recently purchase last March 22, 2023. Safe and age-appropriate toys, play equipment and materials were present. LPA also observed children’s books, puzzles, building blocks, play house and indoor slide, climber, and caterpillar toys at the facility. Per licensee, the daily activity includes playing arts and crafts, letters, numbers, colors, shapes, puzzles, building blocks and watching tv, Licensee states that she also read books and tell stories to children enrolled. During nap time, children nap at the living room using cots provided by the licensee. The smoke detector and carbon monoxide detector were operable. LPA observed electrical outlets are covered with a plastic cover to prevent access to children in care.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. During the inspection, LPA did not observe any razors and/or sharp objects that will pose a health and safety risk to children in care. Cabinets underneath the sink are locked and are in accessible to children. Licensee also provide step tool for children to use.

Currently, there are six children enrolled in the facility. Licensee states that when a child shows signs of illness, he/she is separated from other children in bedroom #1 of the facility.

Outdoor: The facility has no body of water on the premises and the rear yard is off limits to children in care. Licensee stated that she brings children at the Sky tower park for them to play,

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 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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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: HARRY FAMILY CHILD CARE	FACILITY NUMBER: 197419004
	VISIT DATE: 04/26/2023

NARRATIVE

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Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA reviewed five children files and the Licensee files. Based on records review, children files are complete; licensee do not have current mandated reporter training certificate and was completed last February 16, 2021. Per licensee, she will take the mandated reporting training today.

Licensee and other adults living in the home have received criminal record clearance.

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified.

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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-and-resources/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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: HARRY FAMILY CHILD CARE	FACILITY NUMBER: 197419004
	VISIT DATE: 04/26/2023

NARRATIVE

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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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

The facility is not in compliance per Title 22 regulations. 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 was cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

A copy of this Report was reviewed, Notice of Site Visit (LIC 9213) and Appeal Rights were provided to Licensee, Shamika A. Harry.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2023 10:17 AM - It Cannot Be Edited

Created By: Joselito DelMundo On 04/26/2023 at 12:31 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: HARRY FAMILY CHILD CARE	FACILITY NUMBER: 197419004
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not have a current mandated reporter training certificate which posed a potential Health, Safety or Personal Rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee will email a copy of the Mandated Reporter training certificate to LPA.

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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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