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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700716
Report Date: 07/26/2023
Date Signed: 07/26/2023 12:41:53 PM

Document Has Been Signed on 07/26/2023 12:41 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GARCIA AND ALVAREZ FAMILY CHILD CAREFACILITY NUMBER:
197700716
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/26/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Luis Alvarez and Lynda Garcia, ApplicantsTIME COMPLETED:
12:53 PM
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On Wednesday, July 26, 2023, at 9:45 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an announced pre licensing inspection and met with applicants Lynda Garcia and Luis Alvarez who guided LPA Rivera on a tour of the facility. The applicants are requesting a small family childcare license.

Family members residing in the home has been discussed with applicants and are cleared. Operating hours will be Monday to Sunday from 6:00 a.m. to 11:0 p.m. and care for children ages 0 to 13.

This facility is a one-story home that consists of 3-bedrooms, 2- restrooms, kitchen, living room, dining room, garage, front and backyard. All areas identified on the facility sketch were inspected. Areas that are accessible to children and identified on the facility sketch include living room, dining room, bedroom #1 (right side of the hallway), restroom (located in the hallway) and backyard.

Areas off limits to children include- 2 bedrooms (left side) kitchen, garage, front yard, side yards and restroom located in the master bedroom. LPA observed child proof round ball locks on the door knobs and a installed gate barrier between dining room and kitchen.

At approximately 9:55 a.m LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed central air and heater and the vents located on the ceiling wall. LPA observed the thermostat in the hallway and temperature 78 degrees. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA observed cots, one play yard and one crib with a mat and fitted sheets. LPA observed the fire place screen door closed and a toy shelf in front as a barrier. LPA observed the medication stored in the left cabinet located in the hallway and locked with a magnet lock

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARCIA AND ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700716
VISIT DATE: 07/26/2023
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At approximately 10:09 a.m. LPA Rivera observed cleaning compounds items stored underneath kitchen sink with a childproof lock and a key padlock. LPA observed the knives and sharp object stored inside the top kitchen cabinet next to the refrigerator and with a magnet lock making it inaccessible for children to reach and open. For water drinking, LPA observed a water dispenser and applicant stated she will be providing the sippy cups. Applicant stated she will be providing the meals for the children. LPA informed applicant food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated.

At approximately 10:16 a.m., LPA Rivera entered the restroom and observed the toilet, hand washing sink, hand soap and LPA observed the bottom sink cabinet closed and with a child proof lock. LPA did not observe hazard materials and observed the restroom to be in good condition.

LPA Rivera asked applicants if there are any pets, poisons, firearms, weapons, or bodies of water. Applicant Luis stated he has one dog (German Shepard), no poisons and no bodies of water, no firearms, and no weapons. LPA observed one German Shepard (side yard) and no poisons, no firearms, no weapons, nor bodies of water. Applicants were advised that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 10:24 a.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen with the valve on the green area indicating fully charged and purchased receipt dated July 20, 2023. LPA observed carbon monoxide detector and smoke alarm located in the hallway. LPA tested the carbon monoxide and smoke alarm. LPA Rivera heard the sounds and are operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the hallway. For ill/isolation, applicant Lynda stated theliving room will be utilized.

At approximately 10:42 a.m., LPA Rivera inspected the play outdoor (backyard) area that will be used by children for safety, comfort, and cleanliness. LPA observed the yard to be covered with artificial grass, age-appropriate play equipment, furniture and toys. For shade, LPA observed a pergola cover. LPA observed a door that leads to the garage and observed the door closed and locked (key lock). LPA observed the two-side gates closed. LPA informed applicants, during the summer or high heat, for safety purposes children must wear their shoes because the artificial turf gets hot
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARCIA AND ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700716
VISIT DATE: 07/26/2023
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LPA observed applicants Luis Alvarez and Lynda Garcia Pediatric First Aid/ CPR certifications dated April 12, 2023, and Health and Safety certification dated April 14, 2023 (Lynda), May 10, 2023 (Luis) and applicants have proof of immunization against Pertussis, MMR and Influenza vaccine and influenza declination (Luis). Applicants has completed the mandated reporter (AB 1207) training dated April 27, 2023 (Luis), April 21, 2023 ( Lynda). Applicant was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

Applicants stated they plan to care for infants 0-24 months old. LPA informed Applicants of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA provided the LIC 9227 Individual Infant Sleeping Plan and Safe Sleep Log form.

LPA did not observe the required postings LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, and child car seat law poster. LPA informed applicants, the required posting need to be posted in the area where parent can view the information.

The following was also discussed with the applicant:



1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification, a valid criminal record clearance associated to the facility license, immunizations (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARCIA AND ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700716
VISIT DATE: 07/26/2023
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6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.



10. Children and staff records must be maintained and updated as needed and be available for review by the Department.

11. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.



13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

13. Dog(s) and/or pets are recommended to be isolated from children in care.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARCIA AND ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700716
VISIT DATE: 07/26/2023
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14. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

Applicants Luis Alvarez and Lynda Garcia 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.

LPA discussed the safe sleep regulations with applicants Luis Alvarez and Lynda Garcia 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 applicants Luis Alvarez and Lynda Garcia 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.



This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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 Rivera explained in detailed to applicants and provided forms: LIC 311D Forms/Records to Keep in Your Family Child Care Home, LIC 9221 Parent Consent for Administration of Medications and medication chart, LIC 9040 Child Care Facility Roster, LIC 624 Unusual Incident Report, LIC 9227 Individual Infant Sleeping Plan, Safe sleep practices, safe sleep log, the California Car Seat Law Changes (effective February 2018), Effects of Lead Exposure, Shaken Baby Syndrome, and Sudden Infant Death Syndrome (SIDS).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARCIA AND ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700716
VISIT DATE: 07/26/2023
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Corrections needed: Required Licensing Forms posting.

A final review of the application will be completed prior to licensure. Once licensed, the applicants are required to adhere to the terms and limitations stated on the license. Exit interview was conducted with applicants Luis Alvarez and Lynda Garcia.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6