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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830739
Report Date: 06/08/2023
Date Signed: 06/08/2023 12:33:03 PM

Document Has Been Signed on 06/08/2023 12:33 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:MOORE FAMILY CHILD CAREFACILITY NUMBER:
364830739
ADMINISTRATOR:MOORE TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 245-9737
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Donisha Morgan, AssistantTIME COMPLETED:
12:45 PM
NARRATIVE
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On June 8, 2023, Licensing Program Analysts (LPAs) Calloway met with Licensee’s Assistant who granted access. LPA made an unannounced visit for the purpose of conducting a Required Annual Inspection. This is a two story 3-bedroom, 3-bathroom home with kitchen, living room, dining room, laundry room and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include 1 adult (licensee). No daycare children were in care during the inspection, LPA did not observe daycare children. Licensee currently cares for school aged children. Incidental Medical Services (IMS) policy was discussed. Transportation is provided.
Physical Plant: Childcare is provided in the living room and dining room. Children use the bathroom on the right (at entrance). Off limit areas include the entire upstairs (all Bedrooms, laundry, bathroom #2 and #3) and garage (key lock). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room), medicines (upstairs) and hazardous items (sharp knives in upper kitchen cabinet) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. Stairs did not have a gate (no children).
Outside: The backyard is completely fenced. There is no swing/slide. No pets. There is a trampoline (key locked). Declaration provided regarding trampoline off limits to children in care. AC unit in the backyard.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 364830739
VISIT DATE: 06/08/2023
NARRATIVE
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Per Licensee’s Assistant, there are no weapons or firearms inside the home. Age-appropriate napping equipment (mats), toys and books. The required fire extinguisher (2A10BC) and smoke detector and carbon monoxide detector are in operable condition. Fireplace is screened (covered). Home has central AC and heat. CPR/First Aid expires 2/2024. The First Aid kit was observed and is complete. Staff and children’s files were reviewed.

The following was discussed with the Licensee: Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, updated Safe Sleep regulations were provided. The role and responsibilities of being a mandated reporter were reviewed. Everyone working in the home must renew mandated reporter training every two (2) years. www.mandatedreporterca.com. Licensee reminded that 100% supervision is always required to children in care. If food is brought in, it is properly labeled. Check food expiration dates periodically. Licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Report Unusual Incidents to Licensing (LIC 624B) within 24 hours of incident occurring. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban).

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

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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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: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 364830739
VISIT DATE: 06/08/2023
NARRATIVE
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Type A citation: Type A citation(s) 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/are immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) 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 this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee is advised visit www.shotsforschool.org for Immunization information.

--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640

--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 CCL 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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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: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 364830739
VISIT DATE: 06/08/2023
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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

The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm. LPA provided consultation (Safe Sleep) during the inspection.

There are deficiencies cited during this visit. See 809 D pages.

An exit interview was conducted, LPA read and provided a copy of this report and Notice of Site Visit were given to Donisha Morgan, Licensee’s Assistant at the facility.

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

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/08/2023 12:33 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 06/08/2023 at 12:21 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: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 364830739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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Licensee shall provide proof that a fire disaster drill has been conducted by the POC date of 6/22/23.
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, interview, and record review, the licensee did not comply with the section cited above in two out of two staff members (Licensee and Assistant) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2023
Plan of Correction
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Licensee shall provide proof of mandated reporter training no later than POC date of 6/15/23.
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: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/08/2023 12:33 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 06/08/2023 at 12:21 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: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 364830739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in one out of one staff (Assistant) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2023
Plan of Correction
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Licensee shall provide proof to the Department of Assistant's immunizations by POC date of 6/15/23.
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: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023


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