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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360906689
Report Date: 06/24/2024
Date Signed: 06/24/2024 03:54:40 PM

Document Has Been Signed on 06/24/2024 03:54 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/
DIRECTOR:		ROES, SIMONETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 884-2592
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
06/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee Simonetta Roes TIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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On June 24, 2024, at 12:00 p.m., Licensing Program Analyst (LPA) Zirbes met with Licensee Simonetta Roes who guided analyst on a tour of the home for the Annual/Random inspection. Upon arrival, LPA observed two children in care (1 infant, 1 school age child) with the Licensee providing supervision. Based on LPA observation, the child care was meeting the staffing/ratio requirements at the time of this inspection. According to the Licensee currently living in the home are the Licensee, Adult 1, Adult 2 (A2) and child 1. All adults are associated and have eligible clearances. Current hours of operation are Monday to Friday 7:30am -5:30pm.
Physical Plant: 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 and the bathroom located in primary bedroom. The off limit areas of the home were inaccessible via locked doors.
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. During the inspection, LPA did not observe cleaning products in the on limit spaces. Per Licensee, all chemicals and household medications are stored in the off limit areas of the home. Per Licensee, zero medications are currently being provided to the child care children. Knives and sharp items were stored in a high inaccessible kitchen cabinet. LPA observed a smoke detector and carbon monoxide detector in the hallway of the home. The detectors were tested and found to be in working order at the time of this inspection. The home does not have a fireplace. LPA did not observe baby bouncers/saucer chairs, or any recalled and or prohibited toys on the premises. Per Licensee, there are zero firearms or weapons stored in the family child care.

Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
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: 06/24/2024
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Report continued from page one

According to the documentation the fire extinguishers were serviced in June 2024. Therefore the fire extinguishers meets the state fire marshal standards.

During the inspection LPA and Licensee discussed the requirement for Large Family Child Care homes to have single action door handles on exit doors. Based on LPA observation and conversation with the Licensee the exit doors are not equipped with single action door handles, therefore an advisory notice was issued.

Bathrooms (located in the hallway of the home). Toilet, sink, shower/tub were clean and operable. Per Licensee zero chemicals are stored in the bathroom. All personal hygiene materials were stored in areas equipped with child safety locks.



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 retaining block wall and 1/2 chain link. The lower part of the fence is a retaining block wall, the upper section of fence is regular chain link material. The steps leading to the pool are also surrounded by a chain link fence. This chain link fencing surrounding the stairs is smaller chain link measuring less than 1 3/4 inch. 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. The Licensee was licensed prior to 1995. LPA observed age appropriate toys for the children in care and the area was free of hazards.
Per Licensee, there are three dogs on the property who do not interact with the child care children.

LPA reviewed five child files and the Licensees file. Based on LPA record review of the child's files, the Licensee was not updating each child's PM 286 as required. In addition, one of one files reviewed for a child under 12 months of age did not have the Individual Safe Sleeping Plan (LIC 9227) as required. Two technical advisory notices were issued. Per LPA's review of the Licensees file was missing documentation of the measles immunization. A technical advisory notice was issued.

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

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
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: 06/24/2024
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Report continued from page two

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. The following was discussed with the licensee:


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.

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-andresources/
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.

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/.

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

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
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: 06/24/2024
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Report continued from page three

During the exit interview, the Licensee Simonetta Roes, 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.

As a result of this inspection, four technical advisory notices were issued.

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: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
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