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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806088
Report Date: 03/27/2024
Date Signed: 03/27/2024 11:21:39 AM

Document Has Been Signed on 03/27/2024 11:21 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:EVANS FAMILY CHILD CAREFACILITY NUMBER:
364806088
ADMINISTRATOR:EVANS, PAMELA GAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 881-0547
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
03/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Pamela Evans TIME COMPLETED:
11:35 AM
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On March 27, 2024 at 09: 00 a.m., Licensing Program Analyst (LPA) Zirbes met with Licensee Pamela Evans who guided analyst on a tour of the home for the Annual/Random inspection. This is single story home with two bedrooms, one bathroom, living room, dining room, kitchen, detached garage, front and back yard. Per Licensee the living room, kitchen, dining room, bathroom, bedroom 1 and backyard are utilized for the family child care activities. Per licensee off-limit areas of the home are bedroom 2, the garage and the front yard. The off limits areas were inaccessible via key locked doors. Upon arrival, LPA observed a two children in care (one infant, one preschool age) with the Licensee providing supervision. During the inspection two additional children arrived, one preschool age child and an infant. Currently living in the home are the Licensee, and one adult. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 7:30 to 06:00pm.

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. LPA observed cleaning products were stored in the cabinet under the kitchen sink. The cabinet was equipped with a child safety latch. Knives and sharp kitchen items were stored in a high inaccessible kitchen cabinet. Household medications were stored in the off limits bedroom. The fire extinguisher was serviced in May 2023. Safe and age appropriate toys, play equipment and materials were present. LPA observed a smoke detector and carbon monoxide detector in the hallway of the home. The home does not have a fireplace. LPA observed a wall heater located in the hallway of the home. Per Licensee, when the wall heater is in use a child safety gate is placed in the hallway which prevents the children from touching the hot elements. LPA observed the baby gate utilized to make the wall heater inaccessible. 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
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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 3
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: EVANS FAMILY CHILD CARE
FACILITY NUMBER: 364806088
VISIT DATE: 03/27/2024
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Report continued from page one
Bathroom (located in the hallway of the home): Toilet, sink, shower/tub were clean and operable. Zero cleaning products were stored in the bathroom. All personal hygiene materials were stored in inaccessible areas within the shower.
Outdoor: The backyard play space was completely fenced. LPAs observed a dramatic play houses, a tetherball court, and climbing equipment placed on cushion materials. The area was free of hazards at the time of this inspection.

Per Licensee, there were zero pets on the property at the time of this inspection.

LPA reviewed five child files, the Licensees file, one household members file. Per LPA review, all files were complete and contained the required documentation.


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. Per recorded documentation the last fire drill occurred in December 2023.
The following was discussed with the licensee:

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.


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.

Report continued on page three

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

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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: EVANS FAMILY CHILD CARE
FACILITY NUMBER: 364806088
VISIT DATE: 03/27/2024
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Report continued from page two

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/.

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.

During the exit interview, the Licensee Pamela Evans, 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.

Based on LPAs record review there were zero citations issued today.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Pamela Evans.

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

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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