<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700633
Report Date: 08/31/2023
Date Signed: 08/31/2023 02:37:27 PM

Document Has Been Signed on 08/31/2023 02:37 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:MOLINA FAMILY CHILD CAREFACILITY NUMBER:
197700633
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
08/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Susana MolinaTIME COMPLETED:
02:40 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 08/31/2023 at 9:20 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo, conducted a Case Management inspection with Licensee, Susana Molina. The purpose of the case management inspection was 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 07/07/2023. During the inspection, one child was present (1 year old). The Licensee is providing supervision at the time of the inspection. Per licensee, currently residing in the home is the licensee, licensee’s spouse and two children ( 20 and 16).

The home is described as follows:

This is a single-story home with 5 bedrooms and 2 bathrooms, kitchen, dining room, living room, attached garage including the laundry area, shed with a key locked, and a den. Per licensee, the den (playroom) will be the main care area. However, the den is not being use as the main care due to hurricane Hilary. Per licensee, living room, dining area, bathroom #1, and the side yard (outdoor play area) are utilized for child care activities. The off-limits of the home are 5 bedrooms, kitchen, bathroom #2, and attached garage. There is a fireplace located in living room which is made inaccessible to children with a metal screen barrier. The home has central heating and air conditioning.

Indoor: (On limits)
Living room: This area was furnished with fireplace, couches, television, and entertainment center.
Dining Room: Furnished with dining table and chairs, small tables and chairs for little children. Per Licensee, this room will be utilized during meal and snack time.
Den: (Play room): Furnished with an electric fan, tables and chairs, and age appropriate toys. Per licensee, the den is not being use as the main care due to flooding brought about by hurricane Hilary. Licensee also stated that it has to be inspected by the insurance adjuster before licensee try to repair or fix it.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: MOLINA FAMILY CHILD CARE
FACILITY NUMBER: 197700633
VISIT DATE: 08/31/2023
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
26
27
28
29
30
31
32
Pg 2

Bathroom 1: Located between the licensee’s room, hallway closet, and the kitchen. The bathroom was equipped with a toilet, sink, bathtub, and shower. LPA observed paper towels, toilet paper, step stool, trash bin with cover, and liquid hand soap. The bathroom was clean and orderly.

Kitchen: All sharp utensils and knives are stored in the kitchen cabinet, secured with a safety lock, and were inaccessible to the children in care. The refrigerator, stove and microwave are clean. The kitchen is free of hazardous items. The Licensee prepares two meals and one snack for the children in care.
Outside (side yard): The outdoor space is covered with dirt. The outdoor play space was enclosed. LPA observed small slides in the outdoor play area. Per licensee, the outdoor play area will be undergoing repair and licensee is planning on installing turf (grass) or concrete on the outdoor play area. Outdoor play area is not yet ready for accommodation by the children in care.
Napping equipment: LPA observed eleven cots and one crib.
Electrical outlets: All electrical outlets are covered with a safety plug cover and made inaccessible to children.
Weapons or Firearms: Per Licensee, there are firearms in the home, but the ammunitions are stored and lock separately from the firearms.
Cleaning compounds and detergents: Stored under the kitchen sink and were inaccessible via a safety lock.
The smoke detector and carbon monoxide detector: located in the hallway of the home and are in operable condition. The home has a pull-down fire alarm located near the entrance door leading to room #5 (storage room).
Fire extinguisher (2-A:10-B:C) There is a fully charged fire extinguisher (3-A:40-B:C) which meets fire marshal standards. The last service date is on May 24, 2022.
Farm Animals: LPA observed goats that are in the backyard but and does not interact with the child care children.

Off Limit areas:


There is a safety baby gate barricading the entrance to bedrooms #1 to #4.
Bedroom #1 (Master Bedroom and Bathroom) (Off limits): Located alongside the hallway. The bedroom was furnished with a king size bed, tv, restroom, and personal belongings.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MOLINA FAMILY CHILD CARE
FACILITY NUMBER: 197700633
VISIT DATE: 08/31/2023
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
26
27
28
29
30
31
32
Pg 3

Bedroom #2:(Off limits): located between bedroom #3 and the master bedroom. Per licensee, the bedroom is a storage room. The bedroom was furnished with a printer, drawers, safety vault, and personal belongings.
Bedroom #3:(Off limits): located between bedroom #2 and bedroom #4. The bedroom was furnished with a queen size bed, cabinets, and personal belongings.
Bedroom #4:(Off limits): located adjacent to the living room, bedroom #3, and hallway closet with a sliding door. The bedroom was furnished with a twin-size bed, drawers, and personal belongings.
Bedroom #5: (Off limits): Located adjacent to the attached garage and dining room; equipped with exercise equipment and other personal supplies.
Garage (Off limits): Located off the living room. The garage held household items such as tools and other personal items. The attached garage also includes a laundry area. The garage door is self-closing has a double lock to prevent access by children. Per licensee, the door is always lock.

LPA reviewed the Licensee file. All required forms were within the files at the time of this inspection. Per LPAs review, the Licensee has a current mandated reporter training completed on 03/12/2022 and CPR/First Aid training that was completed last 01/22/2022. Licensee’s assistant has current CPR/First Aid training that was completed on 02/18/2023 and mandated reporter training dated 12/08/2022.

Licensee and assistant have proof of immunization against measles, pertussis, and influenza. Licensee and assistant have TB skin test on file.



Licensee and other adults living in the home and associated to the facility 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
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MOLINA FAMILY CHILD CARE
FACILITY NUMBER: 197700633
VISIT DATE: 08/31/2023
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
26
27
28
29
30
31
32
Pg 4

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.

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. LPA also discussed the personal requirements for the new staff person.

The following citations were issued today:

1) the outdoor play area is not ready for use by children in care,

2) the den (playroom) needs to be repair.

As a result of this inspection, the home does not meet Title 22 Regulations. Capacity increase is pending clearance of the cited deficiency and 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, Susana Molina.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 08/31/2023 02:37 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 08/31/2023 at 01:57 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: MOLINA FAMILY CHILD CARE
FACILITY NUMBER: 197700633

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2023
Section Cited
CCR
102417(g)

1
2
3
4
5
6
7
102417 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 be limited to.,,
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will email photos of the corrections/improvements for the playroom.
8
9
10
11
12
13
14
Based on LPAs observation, the den (playroom) needs to be repair as it got flooded during the hurricane Hilary.
8
9
10
11
12
13
14
Type B
10/31/2023
Section Cited
CCR102417(g)(6)

1
2
3
4
5
6
7
102417 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 be limited to...(6)...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will email photos of the corrections/improvements for the outdoor play area.
8
9
10
11
12
13
14
Based on LPAs observation, the outdoor play area is not ready for use by children in care; the play area needs to be clean. Licensee is planning to install turf (grass) or concrete on the outdoor play area.
8
9
10
11
12
13
14
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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
Page: 5 of 5