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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700574
Report Date: 04/26/2022
Date Signed: 04/26/2022 11:58:54 AM

Document Has Been Signed on 04/26/2022 11:58 AM - 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:JONES AND PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197700574
ADMINISTRATOR:KYIAMOWAKI JONESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 670-7428
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/26/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Kyiamowaki Jones and Alma PerezTIME COMPLETED:
12:10 PM
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On April 26, 2022 at 10:00AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Licensees Kyiamowaki Jones and Alma Perez, who guided analyst on a tour of the facility for a Pre-licensing - Change of Location inspection. This is a single story 4 bedroom, 2 bathroom home with kitchen/dining, living room, and detached garage use solely for play. Licensees disclosed they will not use the detached garage for napping. Declaration provided. There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (Both Licensees) and one child. Hours of operation are Monday Through Friday, 6:00AM until 6:00PM. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in living room (at entrance). Children use the bathroom in hallway next to off-limits master bedroom. Off limits areas include Master Bedroom, Bedroom # 2 through #3, and kitchen. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under off-limits kitchen sink), medicines (master bedroom) and hazardous items (sharp knives in upper cabinet of kitchen) that can pose a danger to children. Licensees reminded to conduct fire/earthquake drills every 6 months and document. A Roster was provided to Licensees to complete and maintain.

The backyard is completely fenced. There is a play structure anchored to the ground. Faux grass is used for cushion under play structure. There is one lizard and a fish tank in off-limits bedroom. There is an additional fish tank in the dining room. Licensees provided declaration stating children will not be permitted to have access to fish tank. The backyard is completely fenced and gated all around.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574
VISIT DATE: 04/26/2022
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Per Licensees, there are no weapons or firearms on the premises. LPA did not observe any in the home at this time. There are age appropriate toys. Age appropriate napping equipment (mats). The required fire extinguisher (3A40BC), smoke detector, and carbon monoxide detector are in operable condition. Fireplace is made inaccessible. Home has central AC and heat. CPR/First Aid expire 07/01/2023 (Licensee Perez) and 08/01/2023 (Licensee Jones). Preventive Health and Safety completed 06/09/2018 (Licensee Perez) and 07/28/2018 (Licensee Jones). The Lead Poisoning Prevention Training was completed 04/13/2022 (Both Licensees). The First Aid kit was observed and is complete with no-touch thermometer.

LPA reviewed with licensees 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.

Licensees were advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. Notification of Parent's Rights poster (Palmdale Regional Child Care Office) was provided. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents.

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

Licensees were 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 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574
VISIT DATE: 04/26/2022
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LPA discussed the safe sleep regulations with licensees 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 licensees 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important license-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8am-5pm. LPA provided consultation during the inspection.

Facility is in compliance per Title 22 regulations. No corrections are needed at this time. The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification.

Exit interview conducted and report was reviewed with the licensees Kyiamowaki Jones and Alma Perez.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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