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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364819926
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:23:53 PM

Document Has Been Signed on 05/10/2023 12:23 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:GORE FAMILY CHILD CAREFACILITY NUMBER:
364819926
ADMINISTRATOR:GORE, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 272-1512
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
05/10/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Licensee, Linda GoreTIME COMPLETED:
12:28 PM
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Licensing Program Analyst (LPA), Maddox met with licensee, Linda Gore today for the purpose of conducting an unannounced Annual/Random inspection. Present today were licensee, husband, Licensee's adult daughter, and 1 day care child. The home is a single story family home with 4 bedrooms and 2 bathrooms. **There are no pools, spas or any other bodies of water on the premises. Licensee and husband reside in the home, Licensee's adult daughter was present during this inspection, all adults have fingerprint clearances and associated to the home. exams for T.B., and required immunization's. Licensee is associated to the Early Child Care Education unit with Child Care Resource Center. The family room; backyard; 1 bedroom; and the front bathroom are designated for child care.

Licensees Days/hours of operation are Mon - Fri from 7:00 am to 7:00 pm.

Physical Plant: Home is clean and orderly, fireplace is inaccessible, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC), no one smokes in the home. There is a designated area for ill child(ren) as necessary, there are no weapon/firearms on the premises. Off-limit areas are identified as 3 bedrooms, 1 bathroom, kitchen, and the garage, off limits areas are inaccessible to children.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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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: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926
VISIT DATE: 05/10/2023
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There is a working telephone on the premises. Cleaning compounds are inaccessible to children (located in the garage which is off limits to children). Medicines are inaccessible to children (located licensees bedroom which is off limits to children).

The kitchen is toured and the following are inaccessible - Sharp utensils, lighter and/or matches, open bottles of alcohol are inaccessible. Licensee provides breakfast, lunch, and a snack. Refrigerator and freezer are clean.

Bathroom: The following are inaccessible - air freshener, razor blades, soap, mouthwash, shampoo, razor, nail polish. Toilets and faucets are clean, safe and operable. Bathtub and shower are free of hazards. See TV LIC 9102

Outdoor: The yard was toured and found to be safe for children (inaccessible – lawn mower, gardening tools, poisonous plants, thorn trees, cactus, pets). Licensee must always provide Supervision while children our participating in outside play. LPA observed a shaded covered patio area as you exit onto the backyard, 1 large play apparatus with swing attached and another jungle gym along with other play equipment. This play area is clear and clean of debris. There are age appropriate toys on the patio.

First Aid kit was observed with supplies readily available. Licensee has current Mandated Reporter (exp 8/15/23) and CPR and First Aid training (exp 11/22). All unused electrical outlets are covered. Children nap in Bedroom #1 and sleep on cots.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926
VISIT DATE: 05/10/2023
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LPA reminded Licensee of the requirement to conduct fire and disaster drills once every six months and record it; 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 day care. Licensee maintains a current roster.

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

Licensee was advised of the requirement to report Unusual Incidents. 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 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. Licensee/Applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926
VISIT DATE: 05/10/2023
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Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 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 parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from 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.

No deficiencies observed as a result of this unannounced inspection, home was found to be in substantial compliance with Title 22 Regulations,. Exit interview conducted, copy of this report was read and provided to Licensee, Linda Gore on this date.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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