197419004-9-14-2023-12-CC-JDMO-CVNSHL-20230914135344

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419004
Report Date: 09/14/2023
Date Signed: 09/14/2023 01:54:12 PM

Document Has Been Signed on 09/14/2023 01:54 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:	HARRY FAMILY CHILD CARE		FACILITY NUMBER:	197419004
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	09/14/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Shamika A. Harry		TIME COMPLETED:	01:45 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 09/14/2023 at 9:45 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo, conducted a Case Management inspection with Licensee, Shamika A. Harry. The purpose of the case management inspection was to assess the home for a capacity increase and ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee is requesting to provide care for a Large family childcare home (FCCH) for the capacity of 14 children. Fire clearance was granted on 09/07/2023. During the inspection, three children were present (ages 2 to 4 years old). The Licensee was providing supervision at the time of the inspection. Per licensee, currently residing in the home is the licensee, licensee’s spouse and one minor child (11). The home is described as follows: This is a single-story home with 5 bedrooms and 2 bathrooms, 2 living rooms, dining area, kitchen, and attached garage. Per licensee, living room #1, bedroom #1, and bathroom #1 are utilized for child care activities. The off-limits of the home are 4 bedrooms (master bedroom-#2, #3, #4 and #5), living room #2, bathroom #2 which is inside the master bedroom, kitchen, dining area, backyard, and attached garage. There is a fireplace located in living room #2 which is made inaccessible to children with a glass barrier and is also covered with furniture. The home has central heating and air conditioning unit. Indoor: (On limits) Living room # 1 (Day care area): This area was furnished with a Caterpillar tunnel toy for climbing and crawling, toy house, puzzles, small tables and chairs, children’s books, highchairs, and other age-appropriate toys. Bedroom 1: Located beside living room #1 (Day care area). The bedroom was furnished with 2 cribs, toys, small slide, and a small seesaw. LPA also observed 5 sleeping mats. Per Licensee, this bedroom will be

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: 09/14/2023

NARRATIVE

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utilized when a child shows signs of illness.
Bathroom 1: Located beside the day care area. The bathroom was equipped with a toilet, sink, and shower. LPA observed toilet paper and a step stool. Cabinet under the bathroom sink is locked and inaccessible to children.
Napping equipment: LPA observed 5 sleeping mats and 2 cribs.
Electrical outlets: All electrical outlets are covered with a safety plastic plug and made inaccessible to children.
Weapons or Firearms: Per Licensee, there are no firearms in the home.
Cleaning compounds and detergents: Stored in the laundry room (off-limits) and made inaccessible via a child safety metal gate.
The smoke detector and a carbon monoxide detector: located in the hallway of the home and is in operable condition. The home has a pull-down fire alarm located near the entrance door of the facility.
Fire extinguisher (2-A:10-B:C) There was a fully charged fire extinguisher (3-A:40-B:C) which meets fire marshal standards. It was purchase on February 22, 2023.

Off Limit areas:
Living room # 2: This area was furnished with couches, television, and entertainment center.
Dining Room: Furnished with table, chairs, and a water dispenser.
Kitchen: Per licensee, she does not have any knives and other sharp items in the kitchen. The refrigerator, stove, microwave oven, dishwasher, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. The Licensee prepares meals and snacks for the children in care.
Bedroom #2 (Master Bedroom and Bathroom) (Off limits): Located along the hallway and beside bedroom #3. The bedroom was furnished with a king size bed, cabinet, television, bathroom, and personal belongings. The doorknob has a child safety cover.
Bedroom #3: (Off limits): Located alongside the hallway, beside bedroom #2 and #4. Per licensee, she calls the room as mancave or hangout room. The bedroom was furnished with a couch, television, and personal belongings. The doorknob has a child safety cover.
Bedroom #4 (Off limits): Located alongside bedroom #3; equipped with a loft bed, cabinet, and personal belongings. The doorknob has a child safety cover.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: 09/14/2023

NARRATIVE

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Bedroom #5 (Off limits): Located alongside the laundry room; equipped with chairs, television, and personal belongings. The doorknob has a child safety cover.

Outside (backyard): The backyard is covered with dirt. Per licensee, the backyard is off limits.
Garage (Off limits): Located adjacent to bedroom #5. The garage held household items and 2 vehicles.

All rooms (off limits) and the attached garage are inaccessible via a child safety metal gate at the time of this inspection.

LPA reviewed the Licensee file. All required forms were within the files at the time of this inspection. Per LPAs review, the Licensee has a current mandated reporter training completed on 04/27/2023 and CPR/First Aid training that was completed on 04/29/2023. Licensee has a TB skin test on file.

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

Licensee was made aware of the requirements that she could not have more than 8 children until she has a qualified assistant. Licensee is advised of the requirements when hiring an assistant.

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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: 09/14/2023

NARRATIVE

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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-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.

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

LPA and Licensee discussed the large family home capacity regulations. LPA also discussed the personal requirements for the new staff person.

There were no deficiencies cited today. As a result of this inspection, the home does meet Title 22 Regulations. Capacity increase is pending final approval from the Licensing Program Manager.

Exit interview conducted, a copy of this report, Notice of Site Visit, and appeal rights were provided with the licensee, Shamika A. Harry.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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