197700200-10-19-2023-12-CC-APIN-CWRTW9-20231019150511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700200
Report Date: 10/04/2023
Date Signed: 10/19/2023 03:05:23 PM

Document Has Been Signed on 10/19/2023 03:05 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:	ADENIRAN, ADRIANNE FAMILY CHILD CARE		FACILITY NUMBER:	197700200
ADMINISTRATOR:	ADRIANNE ADENIRAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 920-3354
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	10/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:06 PM
MET WITH:	Licensee Adrianne Adeniran		TIME COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/19/2023 at 12:06pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observed one child in care and one staff providing care and supervision (fingerprint cleared and associated to the home.) The operational childcare hours are Monday through Friday, 6:00am to 5:30pm. This is a two-story family home. There is a living room, dining room, den/classroom, kitchen, four bedrooms, three bathrooms, laundry area, and attached garage. Licensee does provide napping: there are two play yards and six cots for sleeping. The off-limits areas are the four bedrooms, two upstairs bathrooms, laundry area, outdoor play area, and garage made inaccessible by safety knobs/locks and a baby gate. Licensee provides breakfast, lunch, dinner, and a pm snack. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children in care. Hanging window blind cords: The cords are inaccessible to children. Pets: there are no pets on premises. Phone service: There is a working landline and cell phone, charged and kept on staff at all times. Transportation: The Licensee does not provide transportation for children. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris; however, the Licensee has outdoor play in a nearby park with the parent's permission. Continue to next page

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
	VISIT DATE: 10/04/2023

NARRATIVE

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Knives are kept in the kitchen in a high cabinet above the refrigerator, inaccessible to children in care. Medication is kept in the off-limits master bedroom, inaccessible to children in care. Cleaning supplies and chemicals are kept in the kitchen under the sink, inaccessible to children in care.
There are age-appropriate toys and equipment on the premises. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezers, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept high in the hallway closet with a safety knob. The required fire extinguisher (2A10BC) is reading in green, last tested in December 2022. Smoke and carbon monoxide detectors were found to be in operable condition, tested at 12:37pm and 12:28pm, respectively. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 10/1/2023 at 3:30pm for Earthquake/Disaster and/or Fire Drill.

Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148).Licensee does not have separate insurance for the family child care home and has the authorized representatives complete the LIC 282 form.

Licensee was able to provide a valid CPR/First Aid training valid until 11/2023. Child Care Provider Mandated Reporter Training Certificate has been completed and valid until 10/2025. Staff Personnel files were complete with the: Mandated Reporter Training, Immunizations: MMR, Tdap, TB, & Flu shots/statements declining the Flu shot were missing from the file and the Licensee stated that it had been misplaced, the Licensee was provided Technical Assistance in keeping the records in their personnel file, background clearances, and Pediatric First Aid & CPR.

Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process provided to parents, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, and PM 286-California School Immunization Record. The Licensee was missing the school enrollment forms/documentation for the school age child attending which is a Type B violation, see the LIC 809D for the details.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/19/2023 03:05 PM - It Cannot Be Edited

Created By: Andrea Pittman On 10/19/2023 at 02:22 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: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(c)

Child's Records

(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above by not having the children's record of enrollment into elementary school which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/02/2023
	Plan of Correction
1 2 3 4	Licensee plans to send via e-mail a copy of the school enrollment document for the school age child no later than 11/2/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mariela Ramon

LICENSING EVALUATOR NAME:

Andrea Pittman

LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
	VISIT DATE: 10/04/2023

NARRATIVE

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Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

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.

The Licensee was reminded to report Unusual Incidents. 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. The Licensee was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed the 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.

Continue to next page

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
	VISIT DATE: 10/04/2023

NARRATIVE

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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

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/.

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.

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

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is not in compliance, a Type B Deficiency has been cited. Please, see the LIC 809D for the citation. An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Facility Representative.

All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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