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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814955
Report Date: 10/16/2024
Date Signed: 10/16/2024 01:22:46 PM

Document Has Been Signed on 10/16/2024 01:22 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:MALONE FAMILY CHILD CAREFACILITY NUMBER:
364814955
ADMINISTRATOR/
DIRECTOR:		MALONE, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 843-9656
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
10/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Brenda MaloneTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On October 16, 2024, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility. LPA met with Licensee, who granted access. LPA and Licensee toured the home inside and outside for an Annual Random inspection. Residing in the home are the Licensee, one adult, and one minor child. The home is licensed for twelve and fourteen children. LPA observed Licensee’s grandchild was home, upstairs during the inspection. All adults working and residing inside the home have a criminal record clearance and are associated to the facility.
Physical Plant: This is a two story five (5)-bedroom, three (3)-bathroom home with kitchen, dining room, family room, living room, loft, and garage. Childcare is provided: in Bedroom #1 down the hallway from the kitchen on the left. Children’s Bathroom: is in hallway on the right it was observed to be clean, with soap and toilet paper, functioning sink and toilet. There were shampoos under the sink that were removed during the inspection. The unused outlets in the home were covered. The blind cords were tied up high and made inaccessible. LPA observed age-appropriate toys, furniture, and books in good repair. There was no napping equipment. Per Licensee all the children are school aged and do not nap. The home was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, hazardous conditions.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 10/16/2024
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The detergents and cleaning compounds are kept inside the laundry area over the washer and dryer locked. The medicines are kept in off limits bedroom upstairs. The windows are screened, free of bugs, cracks, and debris.
Inside the Kitchen, the items that can pose a danger to children were made inaccessible along with the sharp knives they are inside a locked pantry. Fire and earthquake drills were both current; Fire drill was last conducted on 5/15/24 and earthquake drill was last conducted on: 5/15/24 within the six-month timeframe. The child and parent Roster was current and complete with all information. The required fire extinguisher (2A10BC) was full and observed on the parent wall. The smoke and carbon monoxide detectors were tested as operable. The fireplace is screened, and the home has central AC and heat. The required postings were present on the Parent board. There is a landline phone, and cell phone. The stairs were not gated, there were no small children in care. The fire alarm pull switch was not observed inside the home. Licensee was informed a new fire inspection will need to be conducted and installation of pull switch before scheduling the appointment. There was not a single action door handle. There is a 150- gallon fish tank inside the living room as a body of water. It is secure and per Licensee kids do no play with it.

Off limit areas: Garage locked with key lock, Bedrooms: #2, #3, #4 and #5, Bathrooms #2, Bathroom #3, loft, and laundry area, (near garage-locked).

Outside: The backyard is completely fenced. There was one broken wood slat that need repairing. There were no pets in the yard. Per Licensee there are no pets in the home. LPA observed a large play structure with monkey bars and a slide. It was anchored into the ground.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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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: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 10/16/2024
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There was no cushioning surface underneath the slide. Per Licensee there used to be wood chips but they were removed. There are toys, bikes, and play equipment. LPA did not observe a pool, spa, or body of water on the premises. There were three AC units in the yard uncovered and accessible to children. There were five barbecue grills and one fryer uncovered and a propane tank on the side of the house. There were two small empty wading pools in the pools.

Others: Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any in the home. Required mandated reporter training current, CPR/First Aid (Exp. 12/15/2025 and immunizations were not available. Per Licensee, there is an upcoming appointment to get immunizations done. First Aid kit observed. LPA viewed staff and children’s files and per Licensee there are no infants in care. LPA conducted a staff interview with the licensee. Transportation is provided. Incidental Medical Services (IMS) policy and Safe Sleep regulations were discussed. Per Licensee, the home does not have daycare liability insurance.

The following was discussed with the Licensee:


Maintain capacity and transparency per posted parent rights, Roster requirements (keep updated information always and maintain information for three years), Documentation for disaster drills (fire and earthquake). Mandatory forms, signed, for the children’s/staff files, know updated Safe Sleep regulations. The role and responsibilities of being a mandated reporter. Supervision is always required for children in care. If food is brought in, it is properly labeled. Check food expiration dates periodically. Responsible for knowing the regulations as well as anyone who assists in providing care. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. If day care is closed for the day, no kids show, or Licensee absent, must notify Licensing.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 10/16/2024
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Inaccessibility of hazards must be constantly reassessed depending on the children in care. If the phone number is changed, licensing must be notified. Regulations prohibit the smoking of tobacco in a private residence that is licensed as a family childcare home and areas of the day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exer saucers, 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, 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 Childcare 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.
Type A deficiency: Type A deficiency shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is an immediate risk to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A deficiency to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of the Type A report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) must be placed in the child's file for verification of the Type A deficiency. Failure to do so will result in a civil penalty being assessed.
--Licensee is advised to visit: www.shotsforschool.org for Immunization information.
--Licensee was informed of their responsibility to report suspected Child Abuse (LIC 9108), 1-800-827-8724/760-243-6640. Licensee was informed of the
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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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: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 10/16/2024
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MyChildCarePlan.org website, a
consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
--Family Child Care Providers (Disaster Planning information):
https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Child Care Videos: https://ccld.childcarevideos.org
--Licensee advised to visit the CCLD website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
--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 prior to providing the IMS. 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 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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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: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 10/16/2024
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--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.
--Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.
Reminder: The On- Duty Worker is available for questions at: (661) 202-3318 (Monday-Friday 8am-5pm) and for reporting Unusual Incident Reports (within 24 hours). Written Unusual Incident Reports are sent (using (LIC 624 form) to the following email address: unusualincidentreport@dss.ca.gov within seven (7) days after reporting the incident via telephone.

Per Title 22 Regulations, there were deficiencies cited during this inspection. There are Technical Violations, (TV), See TV pages and 809 D page attached to this report.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit, and Appeal Rights were provided to Brenda Malone, Licensee during the inspection. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain the posting will result in $100 civil penalty. During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/16/2024 01:22 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 10/16/2024 at 01:11 PM
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: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview the licensee did not comply with the section cited above in play structure did not have cushioning material underneath the slide which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/30/2024
Plan of Correction
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I will put wood or rubber chips, rubber mulch, or some other type of cushion and provide proof by correction date.
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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


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