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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419415
Report Date: 06/28/2023
Date Signed: 06/30/2023 02:02:29 PM

Document Has Been Signed on 06/30/2023 02:02 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CRUZ, CLEGG FAMILY CHILD CAREFACILITY NUMBER:
197419415
ADMINISTRATOR:CRUZ, ROSA & CLEGG CINTIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 441-5191
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Rosa CruzTIME COMPLETED:
04:00 PM
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On 6/8/2023, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1-Year inspection at the Cruz, Clegg Family Child Care. Upon arrival, the LPA met with the licensee, Rosa Cruz & Cintia Clegg, who guided the LPA on a tour of the facility. Family members residing in the home include 3 adults (licensee and 2 other adults) and 2 children ( 13, 17 yr). Per LIS, annual facility fees are current. All adults living in the home have been background cleared. There were 2 day-care children (21 months and 20 months) and her assistant (licensee’s daughter) present during this inspection. Pre Guardian, all adults in this facility obtain a criminal record clearance.
This is a large family childcare facility. The hours of operation are Monday through Friday, 24 hours. During the inspection, Per Licensing Information System, annual facility fees were current. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS at this time.
The home is set up as follows: This is a two-story home with 4 bedrooms and 3 bathrooms, with a kitchen, living room, formal dining room, laundry room, family room, and garage (2 cars), and no childcare activities are conducted there. Office/storage area at the entrance on the right and from inside the garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CRUZ, CLEGG FAMILY CHILD CARE
FACILITY NUMBER: 197419415
VISIT DATE: 06/28/2023
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Main Area: Main care is provided in the family room. Children use the bathroom located next to the family room. Children do not have access to the backyard.
· Family Room: In the area, LPA observed age-appropriate toys and furniture for the children. There are games and books on the premises of this facility. The carpets and other materials were observed to be in good condition.
· Children's bathroom: Children will use the bathroom next to the family room. The bathroom was the tour. The bathroom was clean, sanitized, and in good repair. The toilet was inspected, and the sink/toilet is in operable condition. The toilet and faucets are clean, safe, and operable. The bathroom was observed to be free and clear of hazardous items.
Off-limit: The areas include the entire upstairs (4 bedrooms, 2 bathrooms, laundry), Backyard, and garage. kitchen (gated on both sides): During today’s inspection, the kitchen gates were not on. LPA observed medications and sharp knives in the kitchen. LPA asked the licensee to remove all the materials. The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (some Safety latches).
Other:
· AC/Heating Unit was observed. The AC/Heating Unit is located on the right side of the home and is inaccessible to children.
· Bodies of water: Pre the licensee, there were no bodies of water in the home.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Food: The licensee will provide Breakfast, lunch, and snacks.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CRUZ, CLEGG FAMILY CHILD CARE
FACILITY NUMBER: 197419415
VISIT DATE: 06/28/2023
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· Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green and located in the kitchen, inaccessible to children. It meets standards established by the State Fire Marshall.
· Hanging window blind cords: The cords are inaccessible to children.
· Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in the living room
· Medications and cleaning solutions: Detergents/cleaning compounds are kept under the kitchen sink with a magnetic lock. Medications are kept in the kitchen pantry on the top shelf.
· Napping: Children will nap in designated areas with adult supervision. LPA observed 4 mats in the closet. Pre licensee, no school-age children are taking a nap
· Pet: There is a small dog in the facility. The dog does not interact with childcare children
· Phone service: There is a working landline or cell phone
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· The First Aid kit is located in the key-locked closet, inaccessible to children. The First Aid Kit was observed to be complete with supplies and a first aid manual.
· Transportation: The licensee will transport Daycare children.
· Weapons or Firearms: Per Licensee, there are no Firearms at the facility at this time. LPA does not observe any firearms.
Documentation:
· Child files: LPA observed that 5 children's files contained all required licensing documents.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CRUZ, CLEGG FAMILY CHILD CARE
FACILITY NUMBER: 197419415
VISIT DATE: 06/28/2023
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· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with an expiration date (of 08/2023).
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and performed on 6/19/23.
· Immunization: The assistant does not have the required immunizations (MMR and DTaP) and TB in her file. The licensee and her assistant provided a written statement declining the influenza vaccination.
· Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed 2 infants have LIC 9227, and NO the Sleeping logs are in each infant's file. Pre-licensee does not keep the logs. LPA lets the licensee knows the records need to keep for 3 years.
· The licensee does post all required information
· Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 7/26/202
· Staff Personnel File: LPA observed 2 staff information. Some information is missing: IZ record (#1), TB test (#1 and #2), Mandated reporter training (#2)
The following information was discussed with the licensee:
Ø Mandatory Forms for the children's files and provider's files.
Ø The licensee is reminded that 100% supervision is required for children at all times.
Ø Capacity requirements, Roster requirements, and Documentation requirements for disaster drills (fire and earthquake).
Ø Licensee was made aware that it is their responsibility to know the regulations and anyone who assists in providing care. Licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CRUZ, CLEGG FAMILY CHILD CARE
FACILITY NUMBER: 197419415
VISIT DATE: 06/28/2023
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Ø Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
Ø Licensee was advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
Ø The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
Ø Criminal Record Statement: The licensee [or facility representative] 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 support or exemption prior to the 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.
Ø Safe Sleep: LPA discussed the safe sleep regulations with the licensee [or facility representative] 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 the licensee [facility representative] 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.
Ø A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CRUZ, CLEGG FAMILY CHILD CARE
FACILITY NUMBER: 197419415
VISIT DATE: 06/28/2023
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Ø Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
Ø Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Ø 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).
Ø Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations.
Ø Our Quarterly updates come out every 3 months. They are also now 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
Ø The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.


Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

An exit Interview was conducted, and a copy of this Report and a Notice of the Site visit were provided to the licensee, Cruz, Rosa & Clegg Cintia.


SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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Document Has Been Signed on 06/30/2023 02:02 PM - It Cannot Be Edited


Created By: Carol Heath On 06/28/2023 at 03:32 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: CRUZ, CLEGG FAMILY CHILD CARE
FACILITY NUMBER: 197419415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA observed an assistant does not have shot record for MMR and Dtap and TB, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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The licensee agreed to ask her assistant to provide the Shot record and email to the LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023


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