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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700109
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:07:07 PM

Document Has Been Signed on 03/07/2024 12:07 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:GUEVARA FAMILY CHILD CAREFACILITY NUMBER:
197700109
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
03/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jeanette Guevara, LicenseeTIME COMPLETED:
01:15 PM
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On March 7, 2024, Licensing Program Analysts (LPA) Annelise Villa met with Licensee Jeanette Guevara who guided analyst on a tour of the facility for the Three Year Required inspection. Upon arrival, LPA observed 3 preschool age children at the daycare with Licensee and 2 staff caring for them. Family members living in the home are Licensee and 1 minor child. Hours of operation are 7:00 am to 6:00 pm, Monday through Friday. Incidental Medical Services (IMS) policy was discussed. No children in the daycare with IMS.

Physical Plant: This is a two-story 4 bedrooms, 3 bathrooms home with kitchen, family room, living room, dining area, laundry room, front/back yards, and garage. The attached garage was observed to be locked during the time of this inspection. The garage is used for storage only and is garage is off limits to children. Main care is provided in the the family room. Children have access to the bedroom #1 and bathroom #1. The off-limits include bedrooms #2-4, bathroom #2-3, living room, laundry room, garage, and front/back yard. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, and medicines. Hazardous items (sharp knives are located the a kitchen drawer with an operable safety latch and cleaning detergents/compounds are kept in the garage with safety latches and inaccessible to children).

Safe and age-appropriate toys, play equipment and materials were observed. LPA tested the smoke detector and carbon monoxide detector and observed both to be in operable condition. Fire extinguisher (2A10BC) was found to be in operable condition (in the green) located in the kitchen. Electrical outlets were inaccessible. No recalled and or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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: GUEVARA FAMILY CHILD CARE
FACILITY NUMBER: 197700109
VISIT DATE: 03/07/2024
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Bathroom: Children use the restroom located next to bedroom #1. Bathroom #1 is a half bath with no shower or tub. LPA observed toilet and faucet to be clean and operable. LPA did not observe any hazardous materials in Bathroom #1. LPA reminded applicant the children's bathroom must be free of accessible shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover.

Kitchen: The kitchen was observed to be clean and orderly. Sharp utensils are stored in a kitchen cabinet with an operable safety latch and inaccessible to children in care. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, and snacks are provided. Licensee stated she is a participant in a food program.

Outdoor: Children play in the back yard. LPA toured the back yard and observed it to be free of garden tools, poisonous plants, thorn trees, cactus, or lawn mower inaccessible to children. The play area is clear and clean of debris, play area is fenced and gated all around. LPA observed age-appropriate play equipment for children.

Pools/Spas/Bodies of Water: There are no pools, spas, or bodies of water on the premises.

Advisory/Other: First Aid kit was observed in the hallway with supplies readily available. Licensee’s First Aid/CPR is is valid and expires on 10/18/2025. Licensee is already enrolled in a CPR/First Aid course for renewal. Licensee’s Mandated Reporter training expires on 1/2/2026. LPA reminded licensee mandated reporter training and CPR must be completed every 2 years. Per Licensee, there is no smoking in the home. Per Licensee there are no pets on the premises. Last fire/disaster drill was completed on 12/18/2023.

Licensee’s annual fees are current and LPA provided Licensee with PIN and instructions on how to pay. LPA observed all required facility postings on premises. Licensee had the following required posted documents: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203) and Emergency Disaster Plan (LIC 610A), cand Fire/Disaster Log.

Documents Provided and or Discussed: Earthquake Preparedness Checklist (LIC 9148), Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227).

Continued 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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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: GUEVARA FAMILY CHILD CARE
FACILITY NUMBER: 197700109
VISIT DATE: 03/07/2024
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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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep. More information on Infant Safe Sleep procedures can be found online on the CDSS web page at 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.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GUEVARA FAMILY CHILD CARE
FACILITY NUMBER: 197700109
VISIT DATE: 03/07/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Licensee 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.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted, and report was reviewed with the licensee. A notice of site visit was given and must remain posted for 30 days. No citation was given today as a result of this inspection.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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