197700523-5-2-2024-12-CC-JDMO-D4VS45-20240502133210

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700523
Report Date: 05/02/2024
Date Signed: 05/02/2024 01:32:34 PM

Document Has Been Signed on 05/02/2024 01:32 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 CARE		FACILITY NUMBER:	197700523
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	05/02/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:10 AM
MET WITH:	Heather Graham		TIME VISIT/ INSPECTION COMPLETED:	01:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 2, 2024, at 10:10 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo, conducted a Case Management inspection. LPA met with the licensee’s assistant, Heather Graham. The assistant told LPA that the licensee has a doctor’s appointment. LPA stated the purpose of the case management inspection which is to assess the home for a capacity increase and ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee is requesting to provide care for a Large family childcare home (FCCH) for the capacity of 14 children. Fire clearance was granted on April 23, 2024. During the inspection, five children were present in the facility with the assistant providing care and supervision. At 11:25 A.M., the licensee arrived with one child in her care. Per licensee, currently residing in the home is the licensee, licensee’s spouse, and one minor child (5-year-old). The home is described as follows: This is a one-story home with three bedrooms, two bathrooms, kitchen, dining area, living room, garage, and backyard (outdoor play area). Per licensee, the living room and dining area will be the main care areas. The bathroom (bathroom 1) and backyard (outdoor play area) will also be utilized for child care activities. The off-limits of the home are three bedrooms, kitchen, bathroom 2, and the garage. The home has central heating and air conditioning. Indoor: (On limits) Living room (Main care area): LPA observed age-appropriate toys, kitchen and cabinet set toy, working table toy, television, blocks, puzzles, books, crib, play pen, diaper changing table and other toys for children. The pull-down fire alarm is located next to the entrance door. The fireplace is covered with a metal screen. Dining area: LPA observed six sleeping cots, small bed, table, chairs, highchair, storage box, open plastic drawers, and shelves for supplies and materials in the day care.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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: 05/02/2024

NARRATIVE

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Bathroom 1: The bathroom was equipped with a toilet and sink and are in operable conditions. LPA observed toilet paper, trash bin, step stool, potty chair, potty seat cover, wipes, tissue paper, diapers, and liquid hand soap. The bathroom was clean and orderly. LPA did not observed razors and/or sharp objects, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care. LPA observed shampoos are stored under the sink and secured with a child safety latch.

Backyard (Outdoor Play Area): The facility has no body of water on the premises. The play area is made of concrete and turf grass and has a covered patio. The outdoor play area has a covered porch and age-appropriate toys and play equipment. LPA observed slides, toy house, castle toy house, basketball hoop, tables, chairs, water play table, and toy cars.
Napping equipment: LPA observed six sleeping cots and six mats on the side of the dining area and hallway closet.

Off Limit areas:
LPA observes a child safety metal baby gate and a retractable mesh baby gate barricading the kitchen from the dining area.
Kitchen: All sharp utensils and knives are stored in a knife block in the upper cabinet of the kitchen. The refrigerator, stove and microwave are clean. The kitchen is free of hazardous items. The Licensee prepares meals and snacks for the children in care. Per licensee, parents are also allowed to bring food for their children.
Bedroom 1: Adjacent to bedroom 2. Per licensee, the bedroom is considered as an office area; furnished with closet and a couch.
Bedroom 2: Adjacent to bedroom 1. Per licensee, the bedroom was furnished with a twin-size bed (bunk bed), closet, dresser, television, and personal belongings.
Bedroom 3 (Master Bedroom and Bathroom): Located upstairs. Per licensee, the bedroom was furnished with a queen-size bed, closet, dresser, television, and personal belongings. The bedroom is also equipped with a personal bathroom (bathroom 2).
Attached Garage: Located adjacent to the kitchen. LPA observed the garage serves as a storage area for household items. LPA also observed cleaning compounds are stored in the garage.
Electrical outlets: All electrical outlets are covered with a safety plug cover and made inaccessible to children.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 05/02/2024

NARRATIVE

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Weapons or Firearms: Per Licensee, there are no firearms in the home.
Cleaning compounds and detergents: Stored in the lower cabinet of the kitchen.
The smoke detector and carbon monoxide detector: Located along the hallway bathroom and are in operable condition (tested at 11:02 A.M.) The home has a pull-down fire alarm system located by the entrance door of the facility.
Fire extinguisher (2-A:10-B:C) There is a fully charged fire extinguisher (2-A:10-B:C) which meets fire marshal standards. (checked at 11:50 A.M.)
First Aid Kit: Stored inside the hallway cabinet next to the bathroom.
Medications: 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. LPA reviewed the Licensee and assistant files. All required forms were within the files at the time of this inspection. Per LPAs review, the licensee and assistant have a current mandated reporter trainings completed on January 7, 2023, and April 30, 2023; CPR/First Aid trainings were completed last February 24, 2024, and May 13, 2023. Licensee and assistant have proof of immunization against measles and pertussis. Licensee and assistant declined to take the influenza vaccination. Licensee and assistant have TB skin test on file.

Licensee and other adults living and working in the home 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

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: 05/02/2024

NARRATIVE

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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

LPA and Licensee discussed the large family home capacity regulations.

There were no deficiencies cited today. As a result of this inspection, the home does meet Title 22 Regulations. Capacity increase is pending final approval from the Licensing Program Manager.

Exit interview conducted, a copy of this report, Notice of Site Visit, and appeal rights were provided with the licensee, Tyeshia Washington.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC809 (FAS) - (06/04)

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