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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700574
Report Date: 10/25/2023
Date Signed: 10/25/2023 01:09:26 PM

Document Has Been Signed on 10/25/2023 01:09 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: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: 8DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Licensee Alma PerezTIME COMPLETED:
01:15 PM
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On 10/25/2023 at 8:37am, 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 observed 8 children in care and five staff providing care and supervision (fingerprint cleared and associated to the home.)

The operational childcare hours are Monday through Friday, 6:00am to 6:00pm.

This is a one-story family home. There is a living room, kitchen, four bedrooms, two bathrooms, laundry area, backyard, and detached garage located in the backyard. The off-limits areas are the two bedrooms and second bathroom. Licensee does provide napping and four playpens and 14 cots were observed. Licensee provides breakfast, lunch and snacks; children can be bring food from home and it is placed in a refrigerator for the child care, properly labeled; outside food is permitted but must be store bought. 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 blankets and pillows in empty play pens in the infant bedroom, the Licensee placed them in an inaccessible area, technical assistance was provided. Hanging window blind cords: The cords are inaccessible to children. Pets: there are no pets on premises. Phone service: There is a working land line and cell phone, charged and kept on Licensee and staff at all times. Transportation: The Licensee does not provide transportation for children. Isolation occurs in the empty classroom, near the bathroom.

Knives are kept in the kitchen in a high cabinet, inaccessible to children in care. Medication is kept in the off-limits hallway closet with a safety latch, inaccessible to children in care. Cleaning supplies and chemicals are kept in the off-limits hallway closet with a safety latch, inaccessible to children in care.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574
VISIT DATE: 10/25/2023
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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 and equipment; however, LPA observed at 9:38am multiple weeds in the backyard area posing a danger to children in care, this is a Type B, see the LIC 809D for details. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any 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 locked closet in the living room area. The required fire extinguisher (3A40BC) is reading in green. There is a Fire pull installed in the facility; however, at 9:44am, the LPA observed there is not a single action door handle on the front door entry/exit. The Licensee stated they had replaced the door handle after the Fire Marshall installed the Fire Pull due to the locking mechanism not working. This is a Type B violation, see the LIC 809D for details. Smoke and carbon monoxide detectors were found to be in operable condition, tested at 9:36am for the smoke detector; however, LPA observed that at 9:41am that the carbon monoxide was not operating and the Licensee replaced the battery and it was operable at 10:06am. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 9/14/2023 at 10:00am for drills.

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 has insurance coverage for the facility from Hays Companies, Inc. and Assure Child Care, expiring 6/22/2024.

The Licensee provided proof of immunizations against pertussis (TDAP), measles (MMR), and statement declining the Influenza for self; however, the immunizations were not on file for all staff, this is a Technical Violation. Also, the TB is missing for the Licensee and some staff, this is a Technical Violation.

Licensee was able to provide a certification for herself and staff for the Pediatric CPR/First Aid training for an online provider; this is not a valid training. This is a Type B violation, see the LIC 809D for details. Child Care Provider Mandated Reporter Training Certificate has been completed by the Licensee; however, LPA observed that Staff 1 completed the incorrect training and Staff 2 had an expired certificate, this is a Type B violation, see the LIC 809D for details. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, and background clearances.

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

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574
VISIT DATE: 10/25/2023
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Children’s records: files were found to 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, LIC 9212-Family Child Care Consumer Awareness Information, and PM 286-California School Immunization Record. LPA observed the LIC 9150- Parent Notification of Additional Children in Care and school enrollment documents for the 13 enrolled school age children was missing from the children’s records, this is a Type B violation, see the LIC 809D for 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.

Facility Representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.

LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574
VISIT DATE: 10/25/2023
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 LPA also informed the Facility Representative 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..

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 PIN 22-02-


CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



During the exit interview, the Facility Representative confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574
VISIT DATE: 10/25/2023
NARRATIVE
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Per Title 22 Regulations, this facility is not in compliance, four Type B Deficiencies have been cited. Please, see the LIC 809D for the citations.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided via e-mail and discussed with the Facility Representative.

All licensing reports are recommended to be kept for 3 years. 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: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/25/2023 01:09 PM - It Cannot Be Edited


Created By: Andrea Pittman On 10/25/2023 at 12:27 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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and record review, the licensee did not comply with the section cited above not removing the excess weeds in the backyard and not installing a single action door handle on the front door entry which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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The Licensee will e-mail proofs of the removal of the excess weeds from the outdoor play area and the replacement of the door handle to be a single action door handle no later than 11/8/2023.
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 Staff 1 complete the correct training and Staff 2 renew their training timely which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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Licensee will e-mail proof of correct Mandated Reporter Training for Staff 1 and Staff 2 no later than 11/8/2023.
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: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/25/2023 01:09 PM - It Cannot Be Edited


Created By: Andrea Pittman On 10/25/2023 at 12:27 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: JONES AND PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 all of the staff completing an invalid, online training course for Pediatric CPR & First Aid which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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Licensee will e-mail proof of the correct Pediatric CPR and First Aid Training no later than 11/8/2023.
Type B
Section Cited
CCR
102421(c)
Child's Records
(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g).

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 not having the school enrollment forms for any of the 13 school age children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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Licensee will e-mail proof of school enrollment documents for all thirteen of the enrolled school age children attending the child care no later than 11/8/2023.
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: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


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