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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700523
Report Date: 01/22/2024
Date Signed: 01/22/2024 05:50:29 PM

Document Has Been Signed on 01/22/2024 05:50 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:WASHINGTON FAMILY CHILD CAREFACILITY NUMBER:
197700523
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
01/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Tyeshia WashingtonTIME COMPLETED:
05:50 PM
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On 01/22/2024, at 3:07 P.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Washington 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, Tyeshia Washington 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: living room, kitchen space, bathroom #1, and backyard (outdoor play area).

Licensee states the day care hours of operation is Monday to Friday, from 6:00 A.M. to 6:00 P.M. Currently living in the home is the licensee, licensee’s spouse and minor son (5). Licensee is currently not providing transportation to children in care. During this visit, LPA observed six 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. LPA observed all cleaning products and detergents are stored in the lower cabinets of the kitchen (off limits). Knives and other sharp items are stored in the upper cabinets of the kitchen. The kitchen is barricaded with a metal gate and a retractable mesh baby gate.

LPA observed household medications are stored in the hallway cabinet and secured with a child safety lock. 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 meals and snacks.

The facility is a one-story house. There is a fireplace in the facility and is covered with a metal screen. The home has central heating and air conditioning units.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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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: WASHINGTON FAMILY CHILD CARE
FACILITY NUMBER: 197700523
VISIT DATE: 01/22/2024
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Based on records review, fire/earthquake drills were conducted last April 19, 2023, at 10:13 A.M. The facility has a fully charge fire extinguisher with a 2-A:10-B:C classification (reading in green, checked at 4:46 P.M. Safe and age-appropriate toys, puzzles, chairs, cubbies, highchair, diaper changing table, small bed, table, chairs, arts and crafts, abacus toy, learning toys, manipulative toys, water toys, play pen, and baby crib were observed during the inspection. Licensee provides napping equipment like cots (6) and mats (6) for children to use.

Licensee has first aid kit box stored in the hallway cabinet next to the bathroom. The smoke detector and carbon monoxide detector are in operable condition (checked at 4:49 P.M.). LPA observed electrical outlets are covered with a plastic cover to prevent access to children in care. Licensee stated that she owns no firearms, and no one smoke in the facility.

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. LPA also observed step stool, potty seat, paper tissues, liquid soap, wipes and diapers individually labeled with the child’s name inside bathroom #1 during the inspection.



Currently, the licensee has nine children enrolled in the facility. Licensee stated that when a child shows signs of illness, he/she is separated from other children in the corner of the kitchen area of the facility.

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 slides, toy house, castle toy house, basketball, tables, chairs, water play table, and toy cars. Per licensee, she supervised children while playing outside.

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

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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: WASHINGTON FAMILY CHILD CARE
FACILITY NUMBER: 197700523
VISIT DATE: 01/22/2024
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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 assistants’ files. Based on records review, children’s files are complete; licensee and assistants have current mandated reporter trainings that were completed on 01/07/2023, 04/30/2023, and 01/02/2024; CPR/First Aid trainings were completed on 03/05/2022, 10/18/2022, and 06/16/2023. Licensee was advised to inform assistants by taking the in-person CPR/First Aid training, either through the American Red Cross, American Heart Association, or any Emergency Medical Services Authority (EMSA) approved training centers. Licensee and assistants have proof of immunizations against measles, pertussis, and influenza. Licensee declined to take the influenza vaccine. Licensee and assistants have TB skin test on file.

Licensee and other adults living and working at 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 his/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: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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: WASHINGTON FAMILY CHILD CARE
FACILITY NUMBER: 197700523
VISIT DATE: 01/22/2024
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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 Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM to 5:00 PM.

The facility is in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo did not observed deficiencies that may hinder the health and safety of the children in care. No deficiencies were cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.



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, Tyeshia Washington.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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