197700401-5-24-2023-12-CC-JDMO-CS5RDG-20230524125556

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700401
Report Date: 05/24/2023
Date Signed: 05/24/2023 12:56:19 PM

Document Has Been Signed on 05/24/2023 12:56 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:	COLMENERO FAMILY CHILD CARE		FACILITY NUMBER:	197700401
ADMINISTRATOR:	COLMENERO, BRENDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 466-6014
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	05/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Brenda Colmenero		TIME COMPLETED:	01:00 PM

NARRATIVE

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On 05/24/2023, at 10:15 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Colmenero Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee, Brenda Colmenero and stated the reason for the inspection. 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 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, dining room, bathroom #1, and backyard (outdoor play area).

Licensee states the day care hours of operation is Monday to Friday from 4:00 A.M. to 6:00 P.M. Currently living in the home is licensee and four minor children (11, 10, 5 and 4). Licensee is currently providing transportation to children in care. Licensee stated that the drop off time is 7:45 A.M. and the pick-up time is 2:30 P.M. During this visit, LPA observed six children present in the facility. Per licensee, she will be receiving a minor grant for the repair of the facility’s backyard.

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. Per licensee, all cleaning products and detergents are stored in the garage (off limits) which has a gate and a safety knob that cannot be open and inaccessible to children. Knives, cutleries, and other sharp items are stored inside the upper cabinet above the microwave in the kitchen.

Licensee stated that household medications are stored in the drawer upstairs in the licensee’s room. Per licensee, zero medications are currently being provided for the current children in care. Licensee stated that she is a member of the food program and she is providing breakfast, morning snacks, lunch, afternoon snacks, and dinner.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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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Document Has Been Signed on 05/24/2023 12:56 PM - It Cannot Be Edited

Created By: Joselito DelMundo On 05/24/2023 at 11:49 AM

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: COLMENERO FAMILY CHILD CARE	FACILITY NUMBER: 197700401
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not maintain copies of LIC 627 Consent for Emergency Medical Treatment for child #1, #2, #3, #4 and #5 which posed a potential Health, Safety or Personal Rights risk to persons in care.
	POC Due Date: 06/09/2023
	Plan of Correction
1 2 3 4	Licensee will email copies of signed LIC 627 Consent for Emergency Medical Treatment by parents of child #1, #2, #3, #4 and #5 to LPA.

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:

Lady King

LICENSING EVALUATOR NAME:

Joselito DelMundo

LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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: COLMENERO FAMILY CHILD CARE	FACILITY NUMBER: 197700401
	VISIT DATE: 05/24/2023

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The facility is a two-story house. All room upstairs are off limits, and a wooden gate is barricading the entrance upstairs. The fireplace is covered with a metal and a glass door. The home has central heating and air conditioning units.

Licensee stated that fire/earthquake drills were completed last April 22, 2023 and are conducted once a month. The facility has a fully charge fire extinguisher with a 2-A:10-B:C classification and the last service was on May 2, 2023 (reading in green, checked at 11:54 A.M). Safe and age-appropriate toys, art toys, learning equipment, puzzles, blocks and connectors to build (big size) which are not choke hazard were observed during the inspection. Per licensee, she tries to mimic the preschool setting of teaching kids to prepare them for school. LPA observed washable paint brush, crayons and children’s books. Licensee provides napping equipment like 1 crib that rolls and 9 cots. LPA also observed 1 play pen, diaper changing table, tables and chairs to sit around and eat.

Licensee has two first aid kit boxes stored in the hallway closet. The smoke detector and carbon monoxide detector are in operable condition. LPA observed electrical outlets are covered with a plastic cover to prevent access to children in care.

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. During the inspection, 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.

Currently, the licensee has 14 children enrolled in the facility. Licensee stated that when a child shows signs of illness, he/she is separated from other children on the other side of the dining room of the facility. Licensee added that parents of the child that has symptoms are called immediately.

Outdoor: The facility has no body of water on the premises. The outdoor play area has a covered porch and age-appropriate toys and play equipment. LPA observed little bicycles and tricycles and are age-appropriate. Per licensee, she supervised children while playing outside.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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: COLMENERO FAMILY CHILD CARE	FACILITY NUMBER: 197700401
	VISIT DATE: 05/24/2023

NARRATIVE

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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 and the Licensee and assistant’s files. Based on records review, the children’s files are incomplete; licensee and assistant have current mandated reporter training certificates. Licensee and assistants have proof of immunization against influenza, pertussis, and measles. Licensee and assistant have TB skin test on file.

Licensee and other adults working at and associated to the facility have received criminal record clearance.

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.

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 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: COLMENERO FAMILY CHILD CARE	FACILITY NUMBER: 197700401
	VISIT DATE: 05/24/2023

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Pg 4

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

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. Type B deficiency was cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

A copy of this Report was reviewed, Notice of Site Visit (LIC 9213) and Appeal Rights were provided to Licensee, Brenda Colmenero.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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