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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803814
Report Date: 04/02/2024
Date Signed: 04/02/2024 02:26:58 PM

Document Has Been Signed on 04/02/2024 02:26 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:KOFOED-TREWHELLA FAMILY CHILD CAREFACILITY NUMBER:
364803814
ADMINISTRATOR:KOFOED-TREWHELLA, ALISIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 951-8630
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Taylor MartinezTIME COMPLETED:
12:45 PM
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On 04/02/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Kofoed-Trewhella Family Child Care Home. Upon arrival, the LPA met with assitant, Taylor Martinez who guided LPA on a tour of the facility. Licensee arrived shortly after. Family members residing in the home include 3 adults and 2 minor children. All adults living in the house have been background cleared. Per the Licensee, hours of operation are Monday through Friday 6am - 8pm, open for less than 23 hours. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observe 3 children present. Incidental Medical Services (IMS) were discussed.

Physical Plant/ Main care area:
This is a single-story home with 4 bedrooms and 2 bathrooms. Per licensee, care is provided primarily in the play room (next to the kitchen and dining area) bathroom and backyard. Per licensee, the backyard is not currently being used. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed age appropriate safe toys and napping equipment on the premises. Per licensee, there is a designated area for ill/sick children in a corner in a table in the dining area. Children nap in the play room area in mats that are properly stored.

Children's bathroom: Children use the bathroom located in the hallway. The bathroom was observed to be in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: KOFOED-TREWHELLA FAMILY CHILD CARE
FACILITY NUMBER: 364803814
VISIT DATE: 04/02/2024
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Kitchen/Dining Room: The kitchen has a physical barrier, LPA observed a child safety gate installed. Sharp items are located in an upper cabinets in . Per licensee, she does currently have a food program. Meals offered: Breakfast, AM Snack, Lunch, PM Snack and Dinner

Backyard/Outdoor areas: The backyard is fenced in with chain linked fence. The backyard is divided in multiple sections. LPA observed a dog run in the outdoor area (off limits). Per licensee, there are about 8 dogs in the home. The pets do not interact or have contact with the children. The outdoor play area was inspected and was observed to be free of hazards, lose or sharp parts and tools. LPA observed appropriate and safe toys in the play area. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises.

Off-limits: Per licensee, the off-limit areas of the home include the 4 bedrooms, one bathroom. There is a backyard section that remains off limits and the dog run is also off limits. Laundry room and garage are also off limits and are kept locked during business hours.



Fireplace: The fireplace is located in the living room and was observed to be properly barricaded and covered. The fireplace is not currently being used.

Care and Supervision: Licensee is within the ratio for a large facility. The Licensee was reminded that supervision is always required for children in care.

Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.


Smoke Detector was found to be in operable condition, however, the Carbon Monoxide was observed not to be working during inspection. A type B citation was issued for this violation. The First Aid kit was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (2A10BC) reading in Green and currently serviced. The facility currently does have childcare insurance. Per licensee, she currently does offer transportation, LPA observed insurance to be current.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
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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: KOFOED-TREWHELLA FAMILY CHILD CARE
FACILITY NUMBER: 364803814
VISIT DATE: 04/02/2024
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Medications/ Hazardous Materials: Medications are stored in the master bedroom,made inaccessible by a child safety gate. Cleaning compounds are stored in a lower cabinet in the kitchen, secured with a safety latch. There are no firearms in the home.
Incidental Medical Services (IMS): 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 Licensee will not be providing IMS to the children at this time.

Records: Children’s records were observed to be incomplete, Notification of Parents Rights. Staff's file was observed to be incomplete. Assistant did not have current Mandated Reporter, Employee's rights and vaccination records. A type B Violation was issued for this violation. Licensee’s CPR/First Aid is maintained current, it expires on 08/2024. Mandated Reporter Certificate is not maintained current, it expired on 04/15/2024. A type B citation was issued for this violation Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 03/22/2024. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Assistant's file requirements. LPA provided form LIC311D . LPA discussed the safe sleep regulations with licensee Kofoed-Trewhella and discussed the Child Care Licensing Safe Sleep webpage at 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 www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Provider Information Notices (PINs) & Child Care Advocates: You can now sign up for Quarterly Updates on Rules, Regulations, Policies and PINs for one or more programs through our DSS website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe Applicant was informed all forms pertaining to Child Care Licensing can be found at https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Child Care Advocates Program: Provides information and resources about licensed childcare. www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
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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: KOFOED-TREWHELLA FAMILY CHILD CARE
FACILITY NUMBER: 364803814
VISIT DATE: 04/02/2024
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Megan’s Law - On this date, 04/02/2024, 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 addresses. 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.

MyChildCarePlan.org: Family Child Care Home [Applicant, or Licensee] 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.

Criminal Record Clearance: Licensee [or facility representative] 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.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 days of incident to the department. Applicant was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

There were 3 deficiencies cited during today’s inspection. Exit interview conducted and report was reviewed with the licensee Kofoed-Trewhella. A digital copy of the report along with her appeal rights and Notice of Site Visit was sent electronically

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
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Document Has Been Signed on 04/02/2024 02:26 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 04/02/2024 at 11:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KOFOED-TREWHELLA FAMILY CHILD CARE
FACILITY NUMBER: 364803814

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above. LPA observed Carbon Monoxide detector not functioning which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Per licensee, she agrees to send proof of Carbon Monoxide being in operable condition to LPA Beneroso no later than 04/16/2024
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. LPA did not observe Mandated Reporter in her file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Per licensee, she agrees to send proof of Mandated Reporter training completed to LPA Beneroso no later than 04/16/2024
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/02/2024 02:26 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 04/02/2024 at 11:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KOFOED-TREWHELLA FAMILY CHILD CARE
FACILITY NUMBER: 364803814

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited. Licensee did not have an file for the assistant present at the time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Per licensee, she agrees to send proof of complete assistant's file to LPA Beneroso no later than 04/16/2024
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2024


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