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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700272
Report Date: 07/19/2023
Date Signed: 07/19/2023 02:15:14 PM

Document Has Been Signed on 07/19/2023 02:15 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:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197700272
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
07/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Nancy HernandezTIME COMPLETED:
02:10 PM
NARRATIVE
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On 07/19/2023 at 10:15 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo, conducted a Case Management inspection with Licensee, Nancy Hernandez. The purpose of the case management inspection was to assess the home for a capacity increase and ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee is requesting to provide care for a Large family childcare home (FCCH) for the capacity of 14 children. Fire clearance was granted on 07/12/2023. During the inspection, seven children were present (ages 3 to 5 years old). The Licensee and assistant #1 (A #1) were providing supervision at the time of the inspection. Per licensee, currently residing in the home is the licensee, licensee’s spouse and two minor children ( 3 and 5).

The home is described as follows:

This is a single-story home with 3 bedrooms and 2 bathrooms, 2 living rooms, bonus room, dining area, kitchen, and attached garage. Per licensee, living room #1 and #2, bedroom #1, kitchen, dining area, bathroom #1, and side yard (left) are utilized for child care activities. The off-limits of the home are 2 bedrooms (master bedroom and bedroom #3), bathroom #2, backyard, other part of the side yard (right) and attached garage. There is a fireplace located in living room #1 which is made inaccessible to children with a screen/glass barrier and is also covered with a bookshelf. The home has central heating and air conditioning.

Indoor: (On limits)

Living room # 1 (Day care area): This area was furnished with kitchen set toy, grocery set toy, puzzles, cubbies, tables, chairs, children’s books, colors, numbers, shapes, small couch, arts and crafts, and other age-appropriate toys.
Per licensee, she is providing different themes every month for children in care.
Living room # 2: This area was furnished with couches, coffee table, dog kennel, television, and entertainment center.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 07/19/2023 02:15 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 07/19/2023 at 01:46 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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
102416(c)

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102416 ((c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
The requirement is not met as evidenced by:
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Licensee will email a copy of her CPR/First Aid Training certificate to LPA.
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Based on record review, the licensee did not have current CPR/First Aid training which posed a potential Health, Safety or Personal Rights risk to persons in care.
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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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023


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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 07/19/2023
NARRATIVE
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Dining Room: Furnished with table, four chairs, and a bench for older children, also has a small table and four chairs for little children. Per Licensee, this room will be utilized during mealtime.


Kitchen: All sharp utensils, knives, were inaccessible to the children in care. The refrigerator, dishwasher, stove, microwave, air fryer, water dispenser, etc., are clean. The stove kitchen has safety knobs to prevent access from children. The kitchen was clean, orderly, and free of hazardous items. The Licensee prepares two meals and two snacks for the children in care.
Bedroom 1: located beside bedroom #2 and living room #1. The bedroom was furnished with 6 cots and 1 small bed. LPA also observed 5 additional cots and 3 play pens. Per Licensee, this bedroom will be utilized during nap time.
Bathroom 1: Located alongside the hallway. The bathroom was equipped with a toilet, sink, bathtub, and shower. LPA observed paper towels, toilet paper, step stool, and a potty seat. Cleaning compounds for the bathroom are stored under the sink and were inaccessible via safety latch. The bathroom was clean and orderly.
Outside (side yard): The outdoor space is covered with turf. LPA observed small slides, toy cars, small basketball, climbing and swinging rope. The outdoor play space was enclosed.
Napping equipment: LPA observed eleven cots, one small bed, and three play pens.
Electrical outlets: All electrical outlets are covered with a safety plastic cover and made inaccessible to children.
Weapons or Firearms: Per Licensee, there are no firearms in the home.
Cleaning compounds and detergents: Stored in the off-limits garage and under the kitchen sink and were inaccessible via a safety lock.
The smoke detector and a carbon monoxide detector: located in the hallway of the home and is in operable condition. The home has a pull-down fire alarm located near the fireplace and in the entrance door leading to the side yard.
Fire extinguisher (2A10BC) There was a fully charged fire extinguisher (2-A:10-B:C) which meets fire marshal standards. The last service date is on June 9, 2023.
Pet: The family has two dogs. Per Licensee, the dog has immunization records and does not interact with the child care children.

Off Limit areas:


Bedroom #2: (Off limits): located alongside the hallway. The bedroom was furnished with a toddler bed,
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 07/19/2023
NARRATIVE
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twin size bed, toys, and personal belongings. The doorknob leading to the bedroom was equipped with a child safety doorknob cover.
Bedroom #3 (Master Bedroom and Bathroom) (Off limits): Located in front of the hallway. The bedroom was furnished with a queen size bed, tv, restroom, and personal belongings. Per licensee, the entrance door leading to the bonus room will serve as an exit door in case of emergency.
Bedroom #4 (Bonus room) (Off limits): Located alongside the master bedroom; equipped with exercise equipment.
Garage (Off limits): Located off the dining room. The garage held household items such as tools, chemicals, cleaning products and additional toys. The garage door was inaccessible via a child safety doorknob cover at the time of this inspection.

The following was discussed with the licensee:
Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified

Licensee was 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.

LPA discussed the safe sleep regulations with licensee 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 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 07/19/2023
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LPA reviewed the Licensee file and assistant file. All required forms were within the files at the time of this inspection. Per LPAs review, the Licensee has a current mandated reporter training completed on 06/08/2023 but her CPR/First Aid has expired last 06/14/2023. Licensee’s assistant has current mandated reporter training completed on 08/12/2022 and a CPR/First Aid training dated 11/29/2022.

Licensee and assistant have proof of immunization against measles, pertussis, and influenza. Licensee and assistant have TB skin test on file.



Licensee and other adults living in the home have received criminal record clearance.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm



LPA and Licensee discussed the large family home capacity regulations. LPA also discussed the personal requirements for the new staff person.

The following citations were issued today:

Based on LPA observation, record review and statement from the Licensee. Licensee does not have a current CPR/First Aid training therefore the facility was cited a type B citation for regulation 102416 (c) Personnel Requirements.

As a result of this inspection, the home does not meet Title 22 Regulations. Capacity increase is pending clearance of the cited deficiency and final approval from the Licensing Program Manager.

Exit interview conducted, a copy of this report, Notice of Site Visit, and appeal rights were provided with the licensee, Nancy Hernandez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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