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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700948
Report Date: 04/17/2026
Date Signed: 04/17/2026 11:52:39 AM

Document Has Been Signed on 04/17/2026 11:52 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CORNEJO FAMILY CHILD CAREFACILITY NUMBER:
197700948
ADMINISTRATOR/
DIRECTOR:		NATHALY CORNEJOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 251-2763
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
04/17/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Licensee Nathaly CornejoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 4/17/2026, Licensing Program Analyst (LPA) Ana Rodriguez conducted an unannounced annual inspection at Cornejo Family Child Care. Upon arrival, LPA was greeted by the licensee, Nathaly Cornejo, who provided a facility tour. The home is occupied by 2 adults (the licensee and her partner). LPA observed 5 preschool day care children during the inspection and 1 staff. The licensee stated that the facility operates from Monday through Sunday 23 hours. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children currently require IMS.
The home is set up as follows:
This is a two-story house with 5 bedrooms, 3 bathrooms, living room, family room, kitchen, laundry room, and garage. No pool, spa, or body of water is on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, and ventilation. It has central heating and air conditioning, and all windows have screens, free of cracks, bugs, and debris.
Main Area: The living room and family room are for childcare. Children can access bathroom #1 and backyard.
Living Room: LPA observed age-appropriate toys and furniture in the designated childcare areas. There is child-size furniture and several plastic storage bins containing games and toys for the children. The facility also has books available. Mats with educational and learning activities are on the floor and were noted to be in good condition. A TV is used to play educational videos for the children.
Children's Bathroom (#1): The children’s bathroom is near the garage. LPA observed that the toilet and faucets are clean and operable. There is a pedestal sink. No medication cabinet present. The bathroom was found to be clear of any hazardous items.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 197700948
VISIT DATE: 04/17/2026
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Backyard: The backyard was inspected; The children use the backyard for outside play. The backyard is gated all around. The outdoor play area was observed to be free of hazards and loose and sharp parts. LPA observed a dirt area for active play. Right side of the home is off-limits.
Overnight care: According to the Licensee, overnight care will not be provided at this time.
Off-limit: The front yard, entire upstairs (barricaded by safety gate), kitchen (child safety gate on both entry point) laundry room and garage(key lock door knob) are inaccessible to the daycare children.

Additional Information: According to the licensee, there were no bodies of water in the home. LPA did not observe any bodies of water. An AC/Heating unit is located on the left side of the home and is inaccessible to children, with a metal gate blocking access. All unused electrical outlets are plugged and inaccessible to children. The licensee provide breakfast, lunch, and snacks. A required fire extinguisher (2A10BC) was observed mounted in the living room to the right of the main entrance. It is reading in the green zone, inaccessible to children, and meets standards established by the State Fire Marshal. It was last serviced on 11/2025. If a child shows signs of illness, they will be separated from other children and near bathroom #1. Detergents and cleaning compounds are stored in the off-limits garage and kitchen. Medications are in a locked upper cabinet in the hall near bathroom #1. Children will nap under adult supervision in the family room. LPA observed 12 cots, 1 playpen, and 1 crib. The home has a working cell phone. Smoke detector and carbon monoxide devices located in the living room were tested at 10:51am and found to be operable. The licensee does not provide transportation for the children. Per the licensee, there are no weapons or firearms at the facility. LPA did not observe any weapons or firearms

Documentation Review: Child Files: LPA reviewed 4 children's records. The files contain all necessary licensing documents with parents’ signatures. One infant does have LIC 9227 form. Sleeping logs were in place by the Safe Sleep Regulation.


Staff Personnel File: During the inspection, LPA reviewed 1 staff file, which included LIC 508, LIC 9052, immunization records, a TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. All required documents were in place.
Immunization Records: The licensee and her assistant have up-to-date immunizations for MMR and DTaP, and both have submitted written statements declining the influenza vaccine.
CPR/First Aid: LPA verified that the licensee has current Pediatric CPR and First Aid certifications, which expires on 2/2027.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 197700948
VISIT DATE: 04/17/2026
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Mandated Reporter Training: The licensee and her assistant completed the online mandated reporter training at www.mandatedreporterca.com.
Fire/Disaster Drill: The licensee conducts fire and disaster drills every six months, with the last drill documented on 3/5/26
Required Postings: LPA observed that the licensee does have the Facility License, Emergency Disaster Plan, Earthquake Preparedness, and Parents' Rights Poster displayed as required.
The following information was discussed with the licensee:
-A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
-The licensee was 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
-Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
-Requirements for fire drills, earthquake drills, and documentation for both.
-The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
-The licensee is reminded that 100% supervision is always required for children.
-The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, contact the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
-The regulation prohibits tobacco smoking in private residences that are licensed as family childcare homes and in those areas of the family childcare home where children are present (24/7 ban).
- 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.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 197700948
VISIT DATE: 04/17/2026
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LPA also informed licensee of the importance of checking for and removing any 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
- Licensee 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.
-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/.
- Licensee 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 Licensee Nathaly Cornejo, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
- To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies are being cited at this time.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Nathaly Cornejo.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC809 (FAS) - (06/04)
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