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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700633
Report Date: 10/04/2023
Date Signed: 10/04/2023 11:16:54 AM

Document Has Been Signed on 10/04/2023 11:16 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MOLINA FAMILY CHILD CAREFACILITY NUMBER:
197700633
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Susana MolinaTIME COMPLETED:
11:00 AM
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On 10/04,2023 at 9:20 A.M. Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an announced in-person inspection of the Molina Family Child Care Home. LPA met with applicant Susana Molina. The purpose of the inspection is to conduct a follow-up Capacity Increase Inspection to review the corrections required for licensure. LPA and Applicant toured the facility inside and out to ensure the home meets State Licensing Title 22 Regulations. During this inspection, there were 2 children being supervised by the applicant and assistant.

During the time of the inspection, the following corrections were observed:

Physical Plant - No Deficiency: 102417(g) LPAs observed the den (playroom) was repaired. Wooden floors were installed on the areas of the playroom that got flooded.

Physical Plant - No Deficiency: 102417(g)(7) Artificial grass was installed on the outdoor play area. LPA observed age-appropriate toys such as climber, small slide, and other play equipment.

The following items needs to be corrected prior to licensure.



Physical Plant - 102417(g): LPA observed dead/dried tree branches that have sharp edges on the outdoor play area. The dried/dead tree branches are still attached to the tree and needs to be prune or trim to make children safe when playing outside.

As a result of this inspection, the home does not meet Title 22 Regulations.

An exit interview was conducted, Notice of Site Visit, and Appeal Rights were provided with the applicant Susana Molina.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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