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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700214
Report Date: 05/16/2023
Date Signed: 05/16/2023 04:31:55 PM

Document Has Been Signed on 05/16/2023 04:31 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:PENA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
197700214
ADMINISTRATOR:PENA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 792-6220
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Maria PenaTIME COMPLETED:
03:30 PM
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On 5/16/2023, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1-Year inspection at the Pena, Maria Family Child Care. Upon arrival, the LPA met with the licensee, Maria Pena, who guided the LPA on a tour of the facility. Individuals that reside in the home include 2 adults (the licensee and her husband). Pre Guardian, all adults in this facility obtain a criminal record clearance.
The hours of operation are Monday through Sunday, 24/7. During today’s inspection, LPA observed 1 childcare child (8 years old) with Licensee and her husband (see LIC 811). Per Licensing Information System, annual facility fees were current. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS at this time.
The home is set up as follows: This is a single-family one-story home. The home has a living room, 2 bedrooms, a kitchen, a dining room, 1 bathroom, and an attached garage. 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 and are free of cracks, bugs, and debris.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 197700214
VISIT DATE: 05/16/2023
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Main Area: Main care is provided in the Family room. Children use the bathroom in the hallway. Children have access to the kitchen and backyard.
· Playroom Room/Formal Dining Room/ Family Room: In the playr), the designated playroom, LPA observed age-appropriate toys and furniture for the children. There are games and books on the premises of this facility. The carpets and other materials were observed to be in good condition. In the family room, additional toys were observed stored in cubbies.
· Children's bathroom Children will use the bathroom down the hall. The bathroom was the tour. The bathroom was clean, sanitized, and in good repair. The toilet was inspected, and the sink/toilet is in operable condition. The toilet and faucets are clean, safe, and operable. The bathroom was observed to be free and clear of hazardous items.
Off-limit: The off-limits are 2 bedrooms, kitchen, and all backyard areas fenced off to children.
Other:
· AC/Heating Unit / Swamp Cooler unit was observed. The AC/Heating Unit is located on the top of the home and is inaccessible to children via barrels blocking access to the AC,
· Bodies of water: Pre the licensee, there were no bodies of water in the home. There is a decorative water fountain that has no water.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Food: The licensee will provide snacks, depending on the children's schedule.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 197700214
VISIT DATE: 05/16/2023
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· Fire extinguisher (3A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green and located in the kitchen, inaccessible to children. It meets standards established by the State Fire Marshall.
· Fireplace: The fireplace was observed in the dining room and is screened to make it inaccessible to the children.
· Hanging window blind cords: The cords are inaccessible to children.
· Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in Family room
· Medications and cleaning solutions: Detergents/cleaning compounds are in the off-limit bedroom, inaccessible to the children. Medications are stored in locked cabinets in the kitchen which are inaccessible to children.
· Napping: Children will not nap in designated areas with adult supervision.
· Pets: There are two small dogs (garage).
· 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 kitchen 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 children. The licensee has a valid California driver's license, valid vehicle insurance, and vehicle registration.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 197700214
VISIT DATE: 05/16/2023
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· 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 1 children's files contained all required licensing documents.
· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with an expiration date (of 06/2024).
· Fire Drill and Disaster Drill: Per the licensee, fire, and disaster drills are conducted every 6 months; the last drill was documented and performed on 11/2023.
· 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.
· Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA shared the information with the licensee. Per the licensee, NO infant (0-12 months) is enrolled in the facility.
· The licensee (does not) post all required information
· Mandated Reporter Training: The licensee will need to complete and renewed the online mandated reporter training at www.mandatedreporterca.com

The following information was discussed with the licensee:
ü Mandatory Forms for the children's files and provider's files.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 197700214
VISIT DATE: 05/16/2023
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ü The licensee is reminded that 100% supervision is required for children at all times.
ü Capacity requirements, Roster requirements, and Documentation requirements for disaster drills (fire and earthquake).
ü Licensee was made aware that it is their responsibility to know the regulations and anyone who assists in providing care. 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.
ü Licensee was advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
ü 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).
ü Criminal Record Statement: The licensee [or facility representative] 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 support or exemption prior to the 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 197700214
VISIT DATE: 05/16/2023
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Safe Sleep: LPA discussed the safe sleep regulations with the licensee [or facility representative] 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 the licensee [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.
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.
Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
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 day care home where children are present (24/7 ban).
Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations.
nOur 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
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 197700214
VISIT DATE: 05/16/2023
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ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.

ü A copy of the Safe Sleep Proposed Regulations was provided to the licensee.

No deficiencies are being cited at this time; the facility complies with Title 22


An exit interview was conducted, and the report was reviewed with the licensee Maria Pena.

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

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
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