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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700468
Report Date: 07/13/2023
Date Signed: 07/13/2023 02:47:45 PM

Document Has Been Signed on 07/13/2023 02:47 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:HART FAMILY CHILD CAREFACILITY NUMBER:
197700468
ADMINISTRATOR:HART, JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 230-5995
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
07/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Licensee Joyce HartTIME COMPLETED:
03:15 PM
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On 7/13/2023 at 9:44am, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observe 6 children in care and two staff providing care and supervision (fingerprint cleared and associated to the center.)

The operational childcare hours are Monday through Sunday varied up to 23 hours depending on family's need.

This is a one-story family home. There is a living room, kitchen, three bedrooms, two bathrooms, laundry area, covered patio, and detached garage but not accessible from inside the home. Licensee does provide napping, there are 10 mats, one play yard, and one crib. The off-limits areas are the three bedrooms, one bathroom, laundry area and garage. Licensee provides breakfast, lunch, dinner, and snacks. Children are allowed to bring food from home and is placed in a refrigerator with their name and date labeled on the packaging. 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. Hanging window blind cords: The cords are inaccessible to children. Pets: there are three pets on premises: one French bull dog, one English bull dog, and one lizard. Phone service: There is a working landline and cell phone, charged and kept on staff at all times. Transportation: The Licensee does provide transportation for children: the Licensee's driver license expires 4/6/2024, the AAA vehicle insurance expires 2/28/2024, and the vehicle: 2019 Dodge Journey registration expires 6/24/2024.
Knives are kept in the off-limits kitchen in a cabinet with a safety latch, inaccessible to children in care. Medication is kept in the hallway in a high cabinet with a safety latch, inaccessible to children in care. Cleaning supplies and chemicals are kept in the inaccessible laundry room in a locked cabinet and under the kitchen sink with a safety latch away from children in care.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: HART FAMILY CHILD CARE
FACILITY NUMBER: 197700468
VISIT DATE: 07/13/2023
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There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. The left side yard is barricaded and the Licensee will maintain supervision while children are in the outdoor area to prevent access to the AC unit. There is a covered patio that is used that has a non-functioning wall heater unit and wall thermostat. Licensee signed a LIC 855 Declaration to prevent children from accessing the heater wall unit and ac unit. Per the Licensee, there is one firearm and ammunition in the off-limit bedroom stored separately in individual locked boxes, the Licensee keeps the key on their person at all times. The LPA did not observe any other weapons. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept in a safety latched cabinet in the hallway. The required fire extinguisher (2A10BC) is reading in green. Smoke and carbon monoxide dual detector was found to be in operable condition, tested at 11:40 a.m. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 6/15/2023 at 10:45am.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Licensee does not have in their possession proof of liability insurance for the family child care home and does not have the LIC 282 Form completed in the children’s files. The Licensee will have the parents complete the LIC 282 or provide proof of the facility's liability insurance. This is a Type B violation, see the LIC 809D for the details.

The Licensee provided proof of immunization against pertussis (TDAP), measles (MMR), TB, and statement declining the Influenza for self.



Licensee was not able to provide a valid CPR/First Aid training which expired and needs to be renewed. Child Care Provider Mandated Reporter Training Certificate has expired and needs to be renewed. This is a Type B violation, see the LIC 809D for the details.

Staff Personnel files were found to be incomplete and should include the following required documents: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Training, Immunizations: MMR, Tdap, TB, & Flu shots/statements declining the Flu shot, background clearances, and Pediatric First Aid & CPR. This is a Type B violation, see the LIC 809D for the details.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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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: HART FAMILY CHILD CARE
FACILITY NUMBER: 197700468
VISIT DATE: 07/13/2023
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Children’s records: files were found to be incomplete and should include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, and PM 286-California School Immunization Record. This is a Type B violation, see the LIC 809D for the details.

Licensee's facility child roster is current and maintained up to date.



The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

The Licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI, and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please, advise your Analyst of any person who will be visiting regularly or for longer than one week.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

Safe Sleep regulations (under 24 months) were discussed with Licensee and referred to the CCL web site for additional information and PINS. Provided Licensee with an Infant Sleep Plan Form LIC 9227 and the sleep log.

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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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: HART FAMILY CHILD CARE
FACILITY NUMBER: 197700468
VISIT DATE: 07/13/2023
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

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

Child Care Advocates:


To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was found to not be in compliance per Title 22 regulations, there are four Type B Deficiencies being cited today, see the LIC 809D for the details.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with Licensee.

All licensing reports are recommended to be kept for 3 years and the Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/13/2023 02:47 PM - It Cannot Be Edited


Created By: Andrea Pittman On 07/13/2023 at 01:59 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: HART FAMILY CHILD CARE
FACILITY NUMBER: 197700468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023

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 observation, interview, and record review, the Licensee did not comply with the section cited above by not having completed the Mandated Reporter Training prior to the expiration of the certification which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2023
Plan of Correction
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Licensee will e-mail a copy of the completed Mandated Reporter Training for herself and two staff members no later than 7/27/2023.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above by not having completed the Pediatric First Aid & CPR Training prior to the expiration of the certification with an Emergency Medical Services Authority approved provider which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2023
Plan of Correction
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Licensee will e-mail a copy of the completed Pediatric First Aid & CPR Trraining for herself and two staff members no later than 7/27/2023.
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
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/13/2023 02:47 PM - It Cannot Be Edited


Created By: Andrea Pittman On 07/13/2023 at 01:59 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: HART FAMILY CHILD CARE
FACILITY NUMBER: 197700468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above by not having provided the forms LIC 995A, LIC 995E, LIC 9212 to the Parents of children in care during enrollment and maintained a copy in the children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2023
Plan of Correction
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Licensee will have the parents of the enrolled child care children complete the missing forms and notify licensing no later than 7/27/2023 to come out and review the children records at the facility.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above by not having proof of liability insurance or having the Parents of children in care complete the LIC 282 Form during enrollment and maintained a copy in the children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2023
Plan of Correction
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Licensee will have the parents of the enrolled child care children complete the missing forms or obtain proof of liability insurance and notify licensing no later than 7/27/2023 to come out and review the children records at the facility.
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
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023


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