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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493349
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:24:07 PM

Document Has Been Signed on 02/21/2024 04:24 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:NEVAREZ FAMILY CHILD CAREFACILITY NUMBER:
197493349
ADMINISTRATOR:NEVAREZ, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 234-4762
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
02/21/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Jean Debra NevarezTIME COMPLETED:
04:30 PM
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On 2/21/2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced required 3-year inspection at the Nevarez Family Child Care. Upon arrival, the LPA met with the licensee, Debra Nevarez, who guided the LPA on a facility tour. Individuals that reside in the home include 2 adults (licensee and licensee’s daughter) and 2 minor children.
The licensee's assistants were present during this inspection, and 13 childcare children were present. Per the licensee, the hours of operation are Monday through Friday, 24 hours. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS.
The home is set up as follows:
This is a one-story, 4-bedroom, 1 den, 3.5 bathroom home with a kitchen/dining room, family room, living room, laundry room, and garage. There is an in-ground swimming pool on the premises. 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 free of cracks, bugs, and debris.
Main Area: Main care is provided in the family room, Dining room, and Den (for infant naps). Children use the bathroom on the right in the hallway. Children can access the living room, family room, and dining room area.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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Family Room: In the designated playroom, LPA observed age-appropriate toys and furniture for the children. 1 table with a total of 6 chairs was observed. Several plastic storage bins were observed in which games and toys are stored for the children. There are games and books on the premises of this facility. There are mats on the floor with educational/learning activities. The mats were observed to be in good condition. A TV plays educational videos for children and an adult-size couch. In the family room, a fireplace was observed that was properly screened via mirror glass doors. The fireplace is inaccessible to children. In the family room, additional toys were observed to be stored in cubbies.

Children's bathroom (#1): Bathroom: Children will use the bathroom down the hall to the right. The bathroom was toured and inspected, and the sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are inaccessible to children with child safety latches on the sink cabinet. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair. LPA reminded the licensee to make the cleaning supplies inaccessible to the children.

Kitchen/Dining Room: The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). LPA reminded the licensee of the sharp utensils needed to make them inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are under the kitchen sink with a safety latch. Breakfast, lunch, snacks, and dinner are provided. The licensee currently has a food program. Naps are provided in the den room (infant nap room).

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

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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Backyard: The backyard was inspected; The children use the outside backyard for outside play. The backyard is gated all around. The outdoor play area was observed to be free of hazards and loose and sharp parts. LPA observed a mesh fence barricading the in-ground swimming pool. The mesh fence follows Title 22 regulations. There are two outdoor air conditioners inaccessible to children with barricaded wire fences on the side of the home. LPA observed age-appropriate toys. However, there are several toys are broken and need to remove from the facility. The licensee will also need to remove some garden tools before children go outside. Per the licensee, there are two pets on the premises.

Off-limit: Off-limit areas include the entire home (4 bedrooms, two bathrooms). The licensee will put the safety gate back to make the bedroom inaccessible to the children.


Others:
AC/Heating Unit / Swamp Cooler unit was observed. The AC/Heating Unit is located on the right side of the home and is inaccessible to children via barrels blocking access to the unit.
Bodies of water: Per the licensee, there is an in-ground swimming pool. The fences are at least five feet high. The fence does not obscure the pool from view. LPA observed the fences; gates swing away from the pool, self-close, and have a self-latching device no more than six inches from the top of the gate.
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green, located in the kitchen, and inaccessible to children. It meets standards established by the State Fire Marshall.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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Fireplace: The fireplace was observed in the living room and is screened to make it inaccessible to the children.
Hanging window blind cords: No hanging window blind cords.
Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in the family room.
Medications and cleaning solutions: Detergents/cleaning compounds are in the upper kitchen cabinet. Medications are in the off-limits bedroom.
Napping: Children will nap in the designated nap areas with adult supervision. LPA observed 3 cribs in the den.
Overnight Care: According to the licensee, it does not provide overnight care at this time.
Pets: There are two small dogs. The licensee will email the current vaccinations.
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 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 does provide transportation for her grandchildren (8 and 10 years old). The licensee has a valid California driver's license, valid vehicle insurance, and vehicle registration.
Weapons or Firearms: Per the 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: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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· Infant Sleeping Plan (LIC 9227) and Sleeping Log: Two (2) infants enrolled in the facility. The licensee does not have LIC 9227 and Sleeping log in the files. LPA shared the Safe Sleeping Regulation with the licensee.
· Staff Personnel File: LPA observed 1 staff information. LPA observed LIC 508, 9052, IZ, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. The file contained all required licensing documents.
· Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP). The licensee and her assistant provided a written statement declining the influenza vaccination.
· Staffing Ratio and Capacity: This is a large family childcare facility. During the inspection, LPA observed 13 children (11 months – 5 years old).
· Criminal Record: Per Guardian, all adults who live in this facility obtain a criminal record clearance.
· CPR/First Aid: LPA observed that the licensee has current Pediatric CPR and First Aid Training with an expiration date (of 08/2023) 1 hour of nutrition training and (8) hours of Preventive Health and Safety Training.
· Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 2023
· Facility fees: Per the Licensing Information System, annual facility fees were current.
· Fire Drill and Disaster Drill: Per the licensee, fire, and disaster drills are conducted every 6 months; the last drill was documented and conducted on 02/01/24.
· The licensee has posted as required the Facility License, Emergency Disaster plan, Earthquake Preparedness, and Parents' Rights Poster
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
Page: 5 of 11
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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The following information was discussed with the licensee:
o 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.
o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations.
o Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
o Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
Page: 6 of 11
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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o 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
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
o 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).
o 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 childcare home where children are present (24/7 ban).
o Criminal Record Clearance - Family Child Care Homes Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349
VISIT DATE: 02/21/2024
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o IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
o MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
o Megan’s Law - Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
o Notice of Site Visit - Centers and Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.

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/or Health & Safety codes.

Exit interview was conducted, and the report was reviewed with the licensee, Debra Nevarez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
Page: 8 of 11
Document Has Been Signed on 02/21/2024 04:24 PM - It Cannot Be Edited


Created By: Carol Heath On 02/21/2024 at 04:00 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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed a 10 months old infant sleep on the swining for 15mins, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2024
Plan of Correction
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The licensee remove the infant as soon as she falls asleep and move her to the crib.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. The licensee did not fill out the sleeping log, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2024
Plan of Correction
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The licensee will fill out the sleeping log and email to LPA next Wednesday.
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: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/21/2024 04:24 PM - It Cannot Be Edited


Created By: Carol Heath On 02/21/2024 at 04:00 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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197493349

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview and record review, the licensee did not comply with the section cited above. The licensee did not have 2 infant's parent fill out the plan, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2024
Plan of Correction
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The licensee will has parent fill out the LIC 9227 and email to 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: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024


LIC809 (FAS) - (06/04)
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