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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197701102
Report Date: 04/29/2026
Date Signed: 04/29/2026 11:50:31 AM

Document Has Been Signed on 04/29/2026 11:50 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:PERKINS FAMILY CHILD CAREFACILITY NUMBER:
197701102
ADMINISTRATOR/
DIRECTOR:		JACQUELINE PERKINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 733-9876
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/29/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Jacqueline PerkinsTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 04/29/26, Licensing Program Analyst (LPA) Ana Rodriguez conducted a pre-licensing inspection with the applicant, Jacqueline Perkins, to ensure the facility meets licensing requirements. The applicant is requesting to provide care for a large family childcare home with a capacity of 14 children. LPA toured the house in and out. Individuals who reside in the home include 2 adults (applicant and applicants mother) and 1 minor child. Per Guardian, only 1 adult in this facility has obtained a criminal record clearance and is associated with the facility. Applicants mother will need to be associated to the facility prior to licensing.
During today's inspection, 0 children were with the applicant. The applicant's hours of operation are Sunday through Saturday 12:00am-11:30pm. The Incident Medical Services (IMS) policy was discussed. The applicant will provide IMS at this time.

The home is described as follows: This two-story home consists of a 5-bedroom, 3-bathroom home with a kitchen/dining area, family room, living room, formal dining room, laundry, and 3 car garage. There are no bodies of water on the premises.
Main area: Main care is provided in the Living room and formal dining room. Children use the bathroom near bedroom #1. Children can access the backyard.
Living room: The fireplace is in the Living room it is screened with glass doors to make it inaccessible to the children. LPA observed many age-appropriate toys, books, and other materials. Per the applicant, the children will nap in the living room.
Bathroom #1 (children’s bathroom): Children will use bathroom #1. Bathroom #1 was toured and inspected. The toilet and faucets are clean, safe, and in operable condition. The shower area is free of hazards. No medication cabinet present. No medication, personal items, hazards, or cleaning supplies in the bathroom.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2026
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 197701102
VISIT DATE: 04/29/2026
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Outside: The backyard was inspected. It is completely fenced (cinder block). The patio and left-side outdoor area are accessible to the children. The right side is made inaccessible to the day care children with a metal gate. There are age-appropriate toys. LPA observed a dirt and concrete area for active play and a covered patio with two fans to provide shade. Applicant was reminded to supervise children constantly while playing in the backyard.
Off-limit area: The areas include all bedrooms #1-5, bathroom #2 and #3, pantry, laundry room (safety knob), and 3 car garage.
Bedrooms: Bedroom #1 key lock (applicants mother), bedrooms 2-5 upstairs made off limits with child safety gate. Bedroom #2 ( minor), Bedroom #3 (office), and Bedroom #4 (spare bedroom) The master bedroom (applicant)
Bathroom #2 and 3: upstairs made off limits with child safety gate. LPA toured and inspected the medicine cabinets. The toilet and sink are in operable condition.
Laundry (key lock): The clean supplies and poison are in the laundry room.
Garage (key lock): LPA inspected the 3 car garage. According to the applicant, it is off-limits for children, and no childcare activities will be conducted there.
-Kitchen/Dining: All sharp utensils, cutlery, cleaning supplies, medicines, drawers, cabinets with plastic bags, and pointy things or small things children can swallow are inaccessible to children. The refrigerator, dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. Medications were stored in the off-limits bedroom.
Other: The AC/Heating Unit is located on the right side of the home and is inaccessible to children via metal fence blocking access to the AC unit. According to the applicant, there were no bodies of water in the home. LPA did not observe any bodies of water.
Electrical outlets: All unused electrical outlets are plugged in and inaccessible to children.
Food: The applicant will enroll in the Food program. The applicant will provide Breakfast, lunch, dinner and snacks, or the food can be brought from home. The containers shall be labeled with the children’s names and properly stored or refrigerated.
Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green. It is located mounted in the kitchen and inaccessible to children. It meets standards established by the State Fire Marshal.
Hanging window blind cords: The cords are inaccessible to children.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 197701102
VISIT DATE: 04/29/2026
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Isolation area (Illness): Per the applicant, if the child shows signs of illness, they will be separated from other children and stay in the formal dining room.
Napping: Children will nap in the living room with adult supervision. LPA observed 5 cots in the formal dining room and 15 in the garage. There is 1 crib in the living room.
Overnight Care: According to the applicant, overnight care will be provided. Applicant was reminded that the provider shall remain awake whenever children are awake. The door to the room where the provider is sleeping as well as the door to the room where the children in care are sleeping shall remain open. If the sleeping arrangements are not situated in such a way that the provider can be assured of hearing a child in care wake up, a digital video and audio monitoring device shall be used. Per applicant she will sleep in the family room near where the children sleep. There is an audible alarm on the main entrance to alert the applicant when someone opens the front door.
Pets: no pets
Phone service: There is a working cell phone.
Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
Transportation: The applicant will provide transportation for children. The applicant has a valid California driver's license, vehicle insurance, and vehicle registration.
Weapons or Firearms: Per the applicant, there are no weapons or firearms at the facility. LPA did not observe any weapons or firearms.
Documentation:
The applicant has current CPR and First Aid Training with expiration dates of 12/2027 and Prevented Health and Safety Training completed on 4/12/2026. She has her fingerprint clearance and TB exam. She has proof of being immunized against influenza, pertussis, and measles. She has proof of Mandated Reporting Training dated 3/13/2025. LPA shared LIC 311D with the applicant.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 197701102
VISIT DATE: 04/29/2026
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The following was discussed with the applicant:
- Applicant was 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, 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 applicant provided proof of control of property.
-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) or (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 reviewed with applicant the LIC 311D, Forms/Records to Keep in your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.
-LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] 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 [applicant, licensee, or facility representative] of the importance of checking for and removing 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.
-On this date, 4/6/26, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 197701102
VISIT DATE: 04/29/2026
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-Applicant was informed of the MyChildCarePlan.org site, 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.
- Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.
-To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
-A baby walker shall not be allowed on the premises of a family childcare 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.
-Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The applicant was reminded that supervision is always required for children in care.
-The applicant 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.
-Applicant was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The applicant 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 applicant is reminded that 100% supervision is required for children at all times.
-The applicant was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 197701102
VISIT DATE: 04/29/2026
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-The regulation prohibits the smoking of tobacco in private residences that is licensed as a family childcare home and in those areas of the family childcare home where children are present (24/7 ban).

Before being licensed, the following is required: Due 5/14/26.

-Adult in home must be fingerprinted and associated to the facility
-Tb test required for adult living in the home


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

Exit interview conducted and report was reviewed with the applicant Jacqueline Perkins.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC809 (FAS) - (06/04)
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