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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700070
Report Date: 08/10/2023
Date Signed: 08/10/2023 11:30:32 AM

Document Has Been Signed on 08/10/2023 11:30 AM - 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:DAVIS AND MARTIN FAMILY CHILD CARE HOMEFACILITY NUMBER:
197700070
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Venise Davis and Tasha Martin, LicenseesTIME COMPLETED:
11:42 AM
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On Thursday, August 10, 2023, at 8:51 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced case management capacity increase inspection and met with licensees Venise Davis and Tasha Martin who guided LPA Rivera on a tour of the facility.

During this inspection, 4 children (2 toddlers and 2 preschoolers) were present. Family members residing in the home was discussed with licensees and are background cleared. Operating hours are Monday to Friday, 6:00 a.m. to 6:00 p.m., and care for children ages 0 to 12 years. Fire clearance was granted on 5/25/23 for capacity of 14.

All areas identified on the facility sketch were inspected by LPA Rivera. This is a two-story home which consists of three bedrooms, three bathrooms, kitchen, living room, garage and back patio. Areas that are accessible to children and identified on the facility sketch include: living room, bathroom (1stfloor) and back patio. Areas off limits to children include: all second floor- three bedrooms and 2 bathrooms, kitchen and garage. LPA observed a gate barrier in place below the stairs, between the living room and main entrance walkway, kitchen and hallway to prevent children going into the off-limit areas.

At approximately 9:02 a.m., LPA observed license, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch and license posted near the main entrance area. LPA also reviewed Child Care Facility Roster.

At approximately 9:17 a.m LPA Rivera, inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and land line). For ventilation, LPA observed central AC/heater and vents located on the ceiling. LPA Rivera observed the furniture, children’s materials, and cots to be age appropriate and in good condition. Due to no infants under 12 months enrolled, LPA did not observe a play yard or crib.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 197700070
VISIT DATE: 08/10/2023
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At approximately 9:25 a.m., LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock in place making it inaccessible to children to open. Knives and sharp objects are stored on the corner of the kitchen counter (gate barrier installed) For drinking water, LPA observed water dispenser and disposable cups. Licensees provides the meals and LPA informed if food is brought from children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. During this visit licensees stated currently have no children with food allergies or prescribed or non-prescribed medication. For ill isolation area, the corner of the living room near the entrance is utilized.


LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensees stated they have one Australian shepherd, poisons are stored in the locked garage, and the community pool is located at the end of complex (not near the home) inaccessible to children and no firearms, or weapons. LPA did not observe the dog, firearms or weapons. LPA observed the community pool to be at the end of the complex away from the home and gated. LPA observed the poisons, to be stored in the lock garage. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

At approximately 9:36 a.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged. LPA did not observe a service tag nor a purchase receipt within the year. LPA informed the fire extinguisher must be serviced annually or purchase within the year and tape the receipt on the extinguisher. LPA observed carbon monoxide detector and the smoke detector located near the main entrance. LPA Rivera tested the carbon monoxide and the smoke detector. Carbon and smoke detectors are operable. LPA observed the first aid kit complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the bathroom. LPA observed the earthquake and fire drill log dated 3/7/23.

At approximately 9:45 a.m, LPA Rivera entered the bathroom and observed the toilet, running water, hand soap and paper towels. Inside the bottom cabinet, LPA did not observe items that can pose a potential hazard to children and observed the cabinet with a childproof lock. LPA observed the bathroom to be in good condition.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 197700070
VISIT DATE: 08/10/2023
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At approximately 9:54 a.m., LPA inspected the outdoor area (patio) used by children for safety, comfort and cleanliness, LPA observed the patio to be fenced all around and the side gate closed, and a gate barrier installed to prevent children going to the side yard. LPA observed the play equipment to be age appropriate, in safe condition, free of sharp, no loose or pointed parts. LPA observed the AC compressor and advised to place a mesh cover on top where the fan is located to prevent children placing their fingers. Children bring out their water bottles.

LPA observed licensees Pediatric First Aid/ CPR certification dated 1/30/2022, Health and Safety certification dated 9/16/2017. Licensees have proof of immunization against Pertussis, MMR and Influenza. Licensees have completed the mandated reporter (AB 1207) training dated August 8, 2023. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

The following was also discussed with licensee:
1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification and a valid criminal record clearance associated to the facility license and immunization's, AB 1207 Child Abuse Mandated Reporter Certificate.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 197700070
VISIT DATE: 08/10/2023
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7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

10. Children and staff records must be maintained and updated as needed and be available for review by the Department.



11. Dog(s) and/or pets are recommended to be isolated from children in care.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

16. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 197700070
VISIT DATE: 08/10/2023
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Criminal Record Statement
Licensees Tasha Martin and Venise Davis were 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.

Safe Sleep


LPA discussed the safe sleep regulations with licensees Tasha Martin and Venise Davis 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 Licensees Tasha Martin and Venise Davis 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.

This facility provides Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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.

During this visit, a technical violation was given for not having the fire extinguisher serviced or purchased with the year (fire inspector approved it on 5/25/230.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensees Tasha Martin and Venise Davis.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC809 (FAS) - (06/04)
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