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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700426
Report Date: 06/16/2022
Date Signed: 06/16/2022 12:39:55 PM

Document Has Been Signed on 06/16/2022 12:39 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197700426
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Diana PerezTIME COMPLETED:
12:54 PM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Diana Perez, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 3 bedroom, 3 bathroom home with kitchen, dining room, living room, den, and garage. There is no pool on the premises. Upon arrival LPA observed 0 children with the licensee.

Physical Plant: Main care is provided in the den and living room. Children use the bathroom in the hallway near the homes garage. Children have access to the living room (school age main care area), den (infant / toddler main care area), dining room, children's bathroom and backyard. Off limit areas include the homes entire upstairs, kitchen, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible under kitchen sink), medicines (inaccessible in top kitchen cabinet) and hazardous items (sharp knives inaccessible in kitchen drawer) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any 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 dining room. Per licensee, there are no firearms/weapons in the home. LPA Dorsey observed a gate that barricades the homes stairs.

The last fire/earthquake drill was completed 04/18/22. Roster complete and maintained current.

Bathroom: Bathroom is free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700426
VISIT DATE: 06/16/2022
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Kitchen: Per licensee the kitchen is off-limits, LPA Dorsey observed the kitchen to be made inaccessible by gate. Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are inaccessible under the sink. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has turf, woodchips, concrete and a sand box area for children to play. LPA observed the toys in the backyard to be in safe condition. The backyard has off-limit areas on the left and right side of the home. LPA Dorsey observed these areas to be made off-limits by gates.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 06/2023. Mandated Reporter was completed 07/13/21. Children nap on mats in the family room and infants nap on cribs in the den.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227, and Infant Sleep Log.

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.

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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Diana Perez.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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