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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801767
Report Date: 09/16/2025
Date Signed: 09/16/2025 04:41:28 PM

Document Has Been Signed on 09/16/2025 04:41 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WALTI FAMILY DAY CAREFACILITY NUMBER:
364801767
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
09/16/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:56 PM
MET WITH:Jacquelin Walti - LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On Tuesday September 16, 2025, at 1:56 PM, Licensing Program Analyst (LPA) Giovanni Cristales met with licensee Jacquelin Walti, who guided analyst on a facility tour. The purpose of the inspection is to conduct an unannounced Annual Inspection. LPA toured the areas of the home utilized for the Family Child Care to ensure the home follows Community Care Licensing Title 22 Regulations. Present during the time of this inspection is Licensee and one (1) infant child. Family members residing in the home include three (3) adults (Licensee, licensee's ex, and adult Son). All adults residing in the home have a Criminal Record Clearance. Days/hours of operation Monday through Wednesday 8:15 am to 4:30 pm. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: This is a single story 3-bedroom, 2-bathroom home with kitchen, living room, den, dining area, enclosed patio, laundry room, garage, back and front yard. There is no pool/or body of water on the premises. The home is clean and orderly, the fireplace is screened with wooden barrier gate, age-appropriate toys and play equipment, a working smoke detector and carbon monoxide detector, and a 2A10BC Fire Extinguisher with needle on the green, no one smokes in the home. There is a designated area for the ill child(ren) as necessary in the living room at the entrance. Per licensee there are no weapons/firearms in the home, facility sketch complete and current. The living room; den; dining area; side yard; enclosed patio room, and 1 bathroom are designated for childcare. Off-limit areas include all Bedrooms #1- #3 (Plastic door knob covers), Bathroom #2, kitchen (metal gate barrier), laundry room and detached garage (key lock). There is a working telephone (cell), The home has central AC and heat.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room), medicines (off-limits bedroom), and hazardous items (sharp knives in kitchen cabinet with safety latch and on top of refrigerator) that can pose a danger to children.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
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: WALTI FAMILY DAY CARE
FACILITY NUMBER: 364801767
VISIT DATE: 09/16/2025
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Safe and age-appropriate toys, play equipment, and materials. Electrical outlets are inaccessible, and no baby bouncer’s saucer chairs or any recalled or prohibited toys or sleep/play equipment were observed on the premises. There is age-appropriate napping (playpen) equipment.

Kitchen/Bathroom: The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children (via child gates and child safety latches). The toilet and faucet are clean and operable. Shower/tub is made inaccessible with latches on sliding doors.

Sharp items (knives in kitchen cabinet with safety latch) are inaccessible and the home has a clean fully stocked food refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Licensee serves Breakfast, lunch and 2 snacks.

Outdoor: The outside play area was clear of chemicals and debris, the entire yard is fenced. The backyard has two sides, side #1 Inaccessible to children with a gate, side #2 accessible to children. Completely fenced (gates on the left and right side). Concrete flooring for proper playing. Age appropriate playing equipment. Per licensee, A.C. unit is not on while children are playing outside.

Advisory/Other: First Aid kit was observed with supplies readily available. The licensee has CPR/First Aid 02/20/2026 and the Mandated Reporter expires 08/10/2027. Electrical outlets are inaccessible. There are no window cords accessible to children (string inaccessible). Fire/earthquake drills were completed and maintained current (07/17/2025). Roster complete and maintained current. LPA observed infant sleep log on a planner notebook. LPA observed one (1) pet dog (Beige Frenchie). Per licensee the dog does not interact with children in care.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The following was discussed with the Licensee:

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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: WALTI FAMILY DAY CARE
FACILITY NUMBER: 364801767
VISIT DATE: 09/16/2025
NARRATIVE
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Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed, to be completed every two years; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is his/her/their 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; Regulation prohibits the smoking of any kind during the operation of the daycare. Per the Licensee no one smokes in the home. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

The license advised of the requirement to report Unusual Incidents. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

The licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to part obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from the parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed change, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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: WALTI FAMILY DAY CARE
FACILITY NUMBER: 364801767
VISIT DATE: 09/16/2025
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The 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, before 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

LPA discussed the safe sleep regulations with the licensee and also instructed the Licensee to visit 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.

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.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiency during today's inspection. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm. An exit interview was conducted, and the report was reviewed with the Licensee Jacquelin Walti.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
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