<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830201
Report Date: 03/08/2023
Date Signed: 03/08/2023 12:04:00 PM

Document Has Been Signed on 03/08/2023 12:04 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:BARAJAS FAMILY CHILD CAREFACILITY NUMBER:
364830201
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
03/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Erika Barajas, LicenseeTIME COMPLETED:
12:17 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA's) Maddox and met with licensee, Erika Barajas today for the purpose of conducting and unannounced Req 1 yr inspection. Licensee guided analyst on a tour of the facility inside and outside. Present today were licensee and 4 children. This is a single story family home with 3 bedrooms and 2 bathrooms. **There are no pools, spas or any other bodies of water on the premises. Per licensee, there are no weapons in the home. All adults in the home (licensee, mom, and 1 adult daughter who no longer lives in the home) have fingerprint clearances and exams for T.B. Licensee utilizes the following areas of the home for child care: Family room, backyard, 1 bathroom, kitchen/dining area, and living room.

Fireplace is inaccessible, home has central heating and air conditioning; 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. The outside play area was clear of chemicals and debris, LPA observed age appropriate toys and play equipment, and the entire yard is fenced. All unused electrical outlets are plugged and play equipment and toys are available.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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 2
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: BARAJAS FAMILY CHILD CARE
FACILITY NUMBER: 364830201
VISIT DATE: 03/08/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. Licensee has current CPR and First Aid training (exp 7/2023). The carbon monoxide devise was tested and operable, LPA observed a fully charged fire extinguisher. Mandated Reporter exp 3/3/24. Licensee keeps a current roster and documentation of Emergency Disaster/Fire Drills (1/2022). The kitchen and bathroom were toured and all hazardous items are inaccessible to children.

******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 o 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 does not provide IMS at this time

There were no violations noted as a result of this inspection.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2