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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360906689
Report Date: 10/12/2022
Date Signed: 10/12/2022 02:24:05 PM

Document Has Been Signed on 10/12/2022 02:24 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:ROES FAMILY DAY CAREFACILITY NUMBER:
360906689
ADMINISTRATOR:ROES, SIMONETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 884-2592
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
10/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Simonetta Roes TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee, Simonetta Roes who guided analyst on a tour of the facility for the One Year Required inspection. This is a single story house with three bedrooms, two bathrooms, kitchen/dining room, living room, activity room/Den. Per Licensee the activity Room/Den, and the bathroom are utilized for the family child care activities. Per licensee off-limit areas of the home are all the bedrooms (secured with child proof door knob covers), bathroom located in master bedroom. Upon arrival, LPA observed one infant and three preschool age children in care with the Licensee providing supervision. Currently living in the home is the Licensee, two adults, and one minor child (10) . All adults are associated and have eligible clearances. Current days and hours of operation are Monday thru Friday 7:30am - 5:30pm.
Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. According to Licensee all cleaning products are stored in an off limits bedroom. The bedroom was inaccessible via a child safety door knob cover. Sharp knives were stored in a high cabinet that was inaccessible to the children in care. Licensee and LPA discussed that the family child care license allows the Licensee to care for children until 12 years of age. Therefore the Licensee had to continually assess the environment to ensure items are inaccessible to children from 0-12. Household medications are stored in the off limits bedrooms and bathroom, The bedrooms are inaccessible via a child safety door knob covers. Per recorded documentation Fire/earthquake drills are completed monthly. The fire extinguisher was bought in 2022.
Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes inside the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The activity room is the designated area for ill children in the child care.
Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ROES FAMILY DAY CARE
FACILITY NUMBER: 360906689
VISIT DATE: 10/12/2022
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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home does not have a fire place. The home has central heating and air conditioning along with window air conditioning units.
Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.
Outdoor: The outdoor space consists of areas of cement and grass, In the backyard there is an in ground pool. The pool is made inaccessible to the children by a fence that is 1/2 block/retainer wall and 1/2 chain link. The lower part of the fence is a retainer block wall, the upper section of fence is regular chain link material. The steps are surrounded by a chain link fence, however, the chain link utilized in this section the spaces between links are smaller than the regular size on regular chain link fence. The gate is self latching and self closing and opens away from the pool area. The latching device is located no more than six inches from the top of the gate. (Licensee was licensed prior to 1995). LPA observed age appropriate toys for the children in care and the area was free of hazards. LPA observed a locked storage shed in the backyard as well.

Per Licensee, there are three dogs in the home. Per Licensee, dogs do not interact with the child care children. Per Licensee the dogs are current on shots.

CPR/First Aid expires 7.9.2024 and mandated reporter training expires 5.28.24.


Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA reviewed six child files, files were complete and contained all required information. LPA also reviewed the Licensees and two household members files. LPA advised the Licensee to utilize the LIC 311D and LIC 126 to ensure all staff/household member files contain all required documentation.
Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings. .
The following were observed: Notification of Parents' Rights (PUB394), License, Emergency and Disaster Information (LIC610A).


Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC809 (FAS) - (06/04)
Page: 2 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: ROES FAMILY DAY CARE
FACILITY NUMBER: 360906689
VISIT DATE: 10/12/2022
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Report continued from page two
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.



The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

Licensee was reminded that all adults 18 and over living or working in the home, 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 Unusual Incident Reports and the need to report within the required time frames. Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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: ROES FAMILY DAY CARE
FACILITY NUMBER: 360906689
VISIT DATE: 10/12/2022
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Based on LPAs record review there were zero citations issued today. LPA issued one technical advisory notice regarding personal records.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Simonetta Roes

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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