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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700374
Report Date: 06/07/2024
Date Signed: 06/07/2024 04:36:50 PM

Document Has Been Signed on 06/07/2024 04:36 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:FULLILOVE FAMILY CHILD CAREFACILITY NUMBER:
197700374
ADMINISTRATOR/
DIRECTOR:		VARLINE FULLILOVEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 406-8233
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:48 PM
MET WITH:Varline FulliloveTIME VISIT/
INSPECTION COMPLETED:
04:36 PM
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On June 7, 2024, at 1:48 P.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Fullilove Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA spoke met with the licensee’s niece and told LPA that the licensee is not at home and will be back in 30 minutes. At 2:18 P.M., the licensee, Varline Fullilove arrived. LPA Del Mundo stated the reason for the inspection. LPA was granted access to the facility. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee provided her file, assistant’s file, and the children’s file.

Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: family room (flex room), bedroom 1, living room, bathroom #1, and backyard (outdoor play area). Licensee has no outstanding fees.

Licensee states the day care hours of operation is 23 hours, seven days a week. Currently living in the home is the licensee and two children (14, 10) Licensee is currently not providing transportation to children in care. During this visit, LPA observed zero children present in the facility.

Physical Plant: 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. The smoke detector and carbon monoxide detector are in operable conditions (tested at 3:20 P.M.). The facility has a fully charge fire extinguisher with a 2-A:10-B:C classification (reading in green, checked at 3:18 P.M.) and meets the State Fire Marshall standards. Licensee stated that she owns firearms. LPA observed the firearm is stored inside a vault and the ammunitions are stored separately. Per licensee, no one smokes in the facility. LPA observed cleaning products and detergents are stored in the laundry room. Per licensee, household medications are stored
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
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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Document Has Been Signed on 06/07/2024 04:36 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 06/07/2024 at 04:09 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: FULLILOVE FAMILY CHILD CARE
FACILITY NUMBER: 197700374

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above by failing to provide the licensee and assistant’s mandated reporter trainings which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 06/21/2024
Plan of Correction
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Licensee and assistant will email copies of their mandated reporter training certificates to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


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: FULLILOVE FAMILY CHILD CARE
FACILITY NUMBER: 197700374
VISIT DATE: 06/07/2024
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inside the licensee’s room and are inaccessible to children. Zero medications are being provided to children in care. Knives are stored in the upper shelves of the kitchen cabinets. Licensee is currently not enrolled in a food program but is providing meals and snacks to children in care. Licensee stated that she will enroll in a food program.

The facility is a one-story house. There is no fireplace in the facility. The home has central heating and air conditioning units.



Based on records review, the fire/earthquake drills were missing. Per licensee, she conducted the fire and disaster drills every 10th of the month. Licensee was advised to send a copy of the fire and disaster drills on Monday, June 10, 2024.

Safe and age-appropriate toys, children’s books, kitchen set toys, doll house, posters, tables, and chairs were observed during the inspection. LPA observed sleeping cots and mats for children to use.

Licensee has first aid kit box stored on the kitchen countertop.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. LPA did not observed razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.



Per licensee, she has twenty-two children enrolled in the facility. LPA observed the LIC9040 Child Care Roster is not updated. Licensee stated that she will update the child care roster. Licensee stated that when a child shows signs of illness, the child is separated from other children by sitting on a table in the family room. Licensee stated that she informs the parents immediately to pick up their child.

Outdoor: The facility has a jacuzzi at the backyard and has a mesh fence to make it inaccessible to children.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
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: FULLILOVE FAMILY CHILD CARE
FACILITY NUMBER: 197700374
VISIT DATE: 06/07/2024
NARRATIVE
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LPA observed the jacuzzi is covered. Licensee was advised to clean the backyard.

At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA reviewed five children’s files, licensee, and assistant’s files. Based on records review, the children’s files are complete. Licensee and assistant have expired mandated reporter training certificate dated 12/23/2021. The licensee and assistant were advised to complete and renew the online mandated reporter training at www.mandatedreporterca.com.

Licensee and assistant have current CPR/First Aid trainings certificate dated 12/12/2023. Licensee and assistant have proof of immunization against measles and pertussis. Licensee and assistant have TB skin test on file.



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

The following was discussed with the licensee:

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



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). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and

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

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
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: FULLILOVE FAMILY CHILD CARE
FACILITY NUMBER: 197700374
VISIT DATE: 06/07/2024
NARRATIVE
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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.

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

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Our Quarterly updates come out every 3 months and are also 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



The Licensee is informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM to 5:00 PM.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
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: FULLILOVE FAMILY CHILD CARE
FACILITY NUMBER: 197700374
VISIT DATE: 06/07/2024
NARRATIVE
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The facility is not in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo observed a deficiency that may hinder the health and safety of the children in care. A Type B deficiency was cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

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

Notice of Site Visit: A Notice of Site Visit (LIC 9213 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.

A copy of this Report was reviewed, and Appeal Rights were also provided to Licensee, Varline Fullilove.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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