197700328-6-15-2023-12-CC-AALH-CSTQUU-20230615122918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700328
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:29:30 PM

Document Has Been Signed on 06/15/2023 12:29 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:	GONZALEZ FAMILY CHILD CARE		FACILITY NUMBER:	197700328
ADMINISTRATOR:	GONZALEZ, PRISCILLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 317-9720
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 8	DATE:	06/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Licensee Priscilla Gonzalez		TIME COMPLETED:	12:50 PM

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On 06/15/2023 Licensing Program Analyst (LPA) Alemoh, met with licensee, Priscilla Gonzalez who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story home with a baby gate barricading the stairway. Upon arrival LPA observed 8 children (1 infant) and 3 adults caring for them. Family members residing in the home include 2 adults (licensee, licensee's husband, licensee younger daughter). Facility hours of operation are Monday - Saturday 24 hours. Depending on the parents request the facility is open on Sundays. Incidental Medical Services (IMS) policy was discussed.

There is a pool on the premises.

Physical Plant: Main care is provided in the living room and the day care room. Both areas are barricaded off by a safety gate. The living room has two cribs, a changing table with extra whips and diapers and age appropriate toys and play equipment. LPA observed the day care room to have age appropriate toys and play equipment. A changing table with extra diapers and whips. Learning materials such as coloring books, blocks, and reading materials. The children use the bathroom located in the hallway to the left. The off-limits areas are all upstairs four bedrooms, second restroom, office and the kitchen. Laundry room and garage are also off limits and are kept locked during business hours with a safety door knob.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700328
	VISIT DATE: 06/15/2023

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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 which are kept in the laundry room and top kitchen cabinet, medicines are kept in licensee's bedroom and hazardous items (sharp knives are kept in the kitchen in the upper cabinet high enough that they are inaccessible to children).

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the living room. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed in May 2023. The fireplace, located in the living room is barricaded off by a safety gate.

Bathroom: LPA observed the toilet and faucet are clean and operable. The shower/tub was free of shampoos and body wash. There are no recalled or prohibited items in the children's bathroom.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the top cabinet which is locked during business hours. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently does have a food program. Naps are provided in cribs, sleeping bags with pillows attached the living room. School age children do not nap.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700328
	VISIT DATE: 06/15/2023

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Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall. There is a fish, and a lizard on the premises. LPA observed age appropriate toys, well secured and safe for children. There is a gated and separate area where licensee keeps a barbecue pit, AC unit and a tool shed which is inaccessible to children.

There is a swimming pool and a spa in the backyard. The bodies of water are completely enclosed by a 5 ft iron fence. On the right side of the pool there is 5ft mesh fence. The fences runs all the way down to the concrete on which it sits, leaving no room between the bottom of the fence and the concrete. There is a window in the day care room that views the pool area. There is a 5ft mesh fence that barricades the pool making the window inaccessible to the pool. The pool gate was tested and observed to be self-closing and self-latching. The gate has an installed mechanism containing a safety latch and key lock to lock the gate and it is located within 6 inches from the top of the gate. The pool gate opens away from the body of water. All items rendering the fence climbable are moved away from the fence. The mesh fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. LPA took photos to document in the file.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 10/2024. Mandated Reporter expires on 08/05/2023. LPA reminded licensee; mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have child care insurance.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700328
	VISIT DATE: 06/15/2023

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Licensee Priscilla 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.

LPA discussed the safe sleep regulations with licensee Priscilla and discussed the Child Care Licensing Safe Sleep 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.

The facility was cited Type B deficiencies according to the California Code Title 22 Regulations (cite regulation). See 809D .

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/15/2023 12:29 PM - It Cannot Be Edited

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: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700328
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Staff #3 did not have immunizations in file, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2023
	Plan of Correction
1 2 3 4	Licensee will send proof of completed immunizations: pertussis (tdap), measles (MMR), influenza (FLU) and tuberculosis (TB) to LPA Alemoh no later than 06/30/2023

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	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC809 (FAS) - (06/04)

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