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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419004
Report Date: 03/26/2024
Date Signed: 03/26/2024 12:34:46 PM

Document Has Been Signed on 03/26/2024 12:34 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 CAREFACILITY NUMBER:
197419004
ADMINISTRATOR:HARRY SHAMIKA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 492-6535
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/26/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Shamika HarryTIME COMPLETED:
12:30 PM
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On 03/26/2024, at 9:25 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 Harry and stated the reason for the inspection. LPA was granted access to the facility. 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 maintained in the facility. Licensee guided the analyst on a tour of the day care areas. The day care takes place in the following areas of the home: Living room, bathroom 1, and bedroom 1.

Licensee states the day care hours of operation is Monday to Friday, from 8:00 A.M. to 5:30 P.M. Currently living in the home is licensee, licensee’s spouse, and minor son (12). The licensee’s spouse (Assistant, A1) is currently providing transportation to children in care. Licensee’s assistant has current California Driver’s License, vehicle registration, and car insurance. During this visit, LPA observed nine children present in the facility with the licensee and assistant providing care and supervision.



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. The smoke detector and carbon monoxide detector are in operable condition (tested at 10:14 A.M.). Per licensee, the fire extinguisher is brand new with a 2-A:10-B:C classification (reading in green, checked at 10:08 A.M.) and the purchase date was 03/11/2024. Licensee stated that she owns no firearms, and no one smoke in the facility. Licensee stated that cleaning products and detergents are stored in the laundry room (off limits) and are inaccessible to children. Licensee also stated that she does not have any sharp knives in the facility. There is metal fence barricading the living room (on limits) from the kitchen (off limits). Per licensee, household medications are stored in the licensee’s room. Licensee stated that zero medications are currently being provided for the current children in care. Licensee is a member of a food program and is providing meals and snacks to children.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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: 03/26/2024
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The facility is a one-story house. There is a fireplace in the family room (off limits) and a television set blocked the fireplace. The home has central heating and air conditioning units.

Based on records review, fire/earthquake drills were conducted on March 1, 2024, and are conducted once a month.



LPA also observed children’s books, puzzles, building blocks, playhouse, small slide, cribs, highchairs, basketball hoop, seesaw, diaper changing table, and climbing net equipment at the facility. LPA also observed sleeping mats for children to use during napping. The emergency first aid kit box is mounted on the wall beside the cubbies in the living room. LPA observed electrical outlets are covered with a safety plug to prevent access by 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 observed step stool, paper towel, and liquid soap inside the bathroom. LPA did not observed razors and/or sharp objects, shampoo, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.



Currently, the licensee has fourteen children enrolled in the facility. Licensee stated that when a child shows signs of illness while at the day care, he/she is separated from other children in bedroom 1 of the facility.

Outdoor: The facility has no body of water on the premises. 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
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
Page: 2 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: 03/26/2024
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report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

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’s files, licensee, and assistant’s files. Based on records review, the children’s files are complete. Per licensee, one of the children present during this inspection started today. Licensee was advised to request a copy of the child’s immunization records from parents and include it on the child’s file. Licensee and assistant have current mandated reporter trainings dated 04/27/2023 and 12/01/2023; CPR/First Aid trainings were completed on 04/29/2023. Licensee and assistant have proof of immunization against measles and pertussis. Licensee declined the influenza vaccine. Licensee and assistant have TB skin test on file.

Licensee and other adult living at the facility have received criminal record clearance.

The following was discussed with the licensee:

The licensee was reminded that 100% supervision is always required for children in care. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must always have the facility’s phone number; 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
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
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: 03/26/2024
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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

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Our Quarterly updates come out every 3 months and are also in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov



The Licensee is informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 A.M. to 5:00 P.M.

The facility is in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo did not observed deficiencies that may hinder the health and safety of the children in care. No deficiencies were cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.



During the exit interview the licensee Shamika Harry confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
Page: 4 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: 03/26/2024
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Notice of Site Visit: A Notice of Site Visit (LIC 9213 was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A copy of this Report was reviewed, and Appeal Rights were also provided to Licensee, Shamika Harry.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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