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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492897
Report Date: 08/31/2022
Date Signed: 08/31/2022 04:27:09 PM

Document Has Been Signed on 08/31/2022 04:27 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:PERKINS FAMILY CHILD CAREFACILITY NUMBER:
197492897
ADMINISTRATOR:PERKINS, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 733-9876
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Jacqueline PerkinsTIME COMPLETED:
04:39 PM
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Licensing Program Analysts (LPA's) Justin Dorsey and Andrew Alemoh met with Licensee, Jacqueline Perkins, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 5 bedroom, 4 bathroom home with office, kitchen, dining room area, family room (main care area), living room laundry room and garage. There is no pool on the premises. Upon arrival LPA observed 7 children with the licensee, assistant #1 and assistant #2.

Physical Plant: Main care is provided in the family room. Children use the bathroom in hallway near the office. Children have access to the family room (main care area), children's bathroom and backyard. Off limit areas include the entire upstairs, all of the homes bedrooms, laundry room, office, kitchen, dining area and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible in top kitchen cabinet), medicines (inaccessible in upstairs bedroom) and hazardous items (sharp knives inaccessible in lock box in pantry) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment on the premises. There is a designated area for ill children as necessary in the office. Per Licensee there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 08/15/22. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 197492897
VISIT DATE: 08/31/2022
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Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack dinner and snack are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are kept in a top kitchen cabinet. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is completely fenced. Per licensee children have not been in the backyard in the past few months due to the heat. LPA's observed some of the backyard equipment to be broken, per licensee she is in the process of removing the equipment. LPA advised licensee to not have children play in the backyard until the broken equipment has been removed. The backyard has concrete and dirt areas for children to play.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 06/11/23. Mandated Reporter was completed 02/10/21. Children nap on mats in the family room.

Documents discussed: Title 22 Personnel Records 102416.1, Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

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 licen 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Jacqueline Perkins.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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