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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360905849
Report Date: 01/20/2022
Date Signed: 01/06/2023 10:05:17 AM

Document Has Been Signed on 01/06/2023 10:05 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:BELTRAN FAMILY DAY CAREFACILITY NUMBER:
360905849
ADMINISTRATOR:BELTRAN, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 855-5914
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
01/20/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Yolanda BeltranTIME COMPLETED:
11:59 AM
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Licensing Program Analysts (LPA's) Maddox met with licensee, Yolanda Beltran today for the purpose of continuing the Annual Inspection that commenced on 12/9/2021. Present today were licensee and 3 day care children. The licensee guided Analyst on a tour of the facility inside and outside. The home is a single story family home with 4 bedrooms and 2 bathrooms. All adults in the home, 4 adults in the home with have fingerprint clearances and exams for T.B. Child Care areas include the the living room; dining area: 1 bathroom, 1 bedroom, backyard.

Licensee can access forms on line at www.ccld.ca.gov . LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility. LPA informed licensee of the Departments Child Care Advocate’s (CCA’s) that can forward Quarterly updates regarding Child Care Licensing’s’ Rules and Regulations. Email address: childcareadvocatesprogram@dss.ca.gov

Licensee is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BELTRAN FAMILY DAY CARE
FACILITY NUMBER: 360905849
VISIT DATE: 01/20/2022
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Licensee is urged visit the U.S. Consumer Product Safety Commission web page at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.

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

There were no violations noted as a result of this inspection.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
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