197700537-7-18-2023-12-CC-AALH-CTUTMV-20230718145146

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700537
Report Date: 07/18/2023
Date Signed: 07/18/2023 02:51:56 PM

Document Has Been Signed on 07/18/2023 02:51 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:	BURLIBEKOVA FAMILY CHILD CARE		FACILITY NUMBER:	197700537
ADMINISTRATOR:	SHOLPAN BURLIBEKOVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 287-6173
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91350
CAPACITY:	14	CENSUS: 12	DATE:	07/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Aida Burlibekova		TIME COMPLETED:	03:00 PM

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On 07/18/2023 Licensing Program Analysts (LPAs) Alamoh and Garcia, met with licensee, who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPAs observed 12 children in care and 3 adults caring for them. Family members residing in the home include 3 adults and 1 minor (licensee, licensee's husband and licensee's mother). Facility hours of operation are Monday - Friday 8:30AM-5PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the family room. The children use the bathroom located in the hallway to the right. The off-limits areas are living room, 2 bedrooms, 1 bathroom and kitchen. Garage are off limits and are kept locked during business hours. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept under kitchen sink as well as children's bathroom, medicines are kept in kitchen cabinet and hazardous items (sharp knives are kept in the kitchen in the upper cabinet high enough that they are inaccessible to children).

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) located in the kitchen are all in operable condition.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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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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: BURLIBEKOVA FAMILY CHILD CARE	FACILITY NUMBER: 197700537
	VISIT DATE: 07/18/2023

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Electrical outlets are inaccessible. No 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 living room. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 07/10/2023.

Bathroom: LPAs observed toilet and faucet are clean and operable. showers/ bath tub is free of any prohibited items.

Kitchen(off limits barricaded by a safety gate: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the children's bathroom and under the kitchen sink with a safety latch. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently does not have a food program. Naps are provided on cots in bedroom 2.

Outdoor: The front yard is off limits. The backyard is completely fenced in with a white picket fence. There are no pets on the premises. LPAs observed age appropriate toys, well secured and safe for children. There is a gated and separate area where licensee keeps a covered barbecue pit inaccessible to children.

There are no bodies of water in the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 12/23. Mandated Reporter expires on 09/30/23, Shoplan 09/30/23, Rustam 3/10/25 . LPAs reminded licensee; mandated reporter training must be completed every 2 years.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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: BURLIBEKOVA FAMILY CHILD CARE	FACILITY NUMBER: 197700537
	VISIT DATE: 07/18/2023

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Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have child care insurance.

Licensee Aida 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.

LPAs discussed the safe sleep regulations with licensee Aida and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew Alemoh	TELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

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