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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841515
Report Date: 10/03/2022
Date Signed: 10/03/2022 12:26:37 PM

Document Has Been Signed on 10/03/2022 12:26 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:EDWARDS FAMILY CHILD CAREFACILITY NUMBER:
364841515
ADMINISTRATOR:EDWARDS, LYDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 800-4378
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
10/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee, Lydia Edwards TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee, Lydia Edwards who guided analyst on a tour of the facility for the One Year Required inspection. This is single story home with four bedrooms, three bathrooms, kitchen/dining room, child care room, living room, laundry room, garage, front and backyard with in ground pool. Per Licensee the kitchen, dining room, child care room, living room, laundry room, and bathroom (located near the kitchen) and the backyard are utilized for child care activities. Per licensee, the off-limit areas of the home are all bedrooms, two bathroom, and garage. The off limits areas were inaccessible via key locked doors. Upon arrival, LPA observed two preschool age children in care with the Licensee providing supervision. Currently living in the home is the Licensee and two adult children. All adults are associated and have eligible clearances. Current days and hours of operation are 7 days a week, 24 hours a week.
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. According to Licensee and LPAs observation, all cleaning products are stored in a key locked cabinet in the laundry room. Sharp knives were stored in a high cabinet that was inaccessible to the children in care. Licensee and LPA discussed that the family child care license allows the Licensee to care for children until 12 years of age. Therefore the Licensee had to continually assess the environment to ensure items are inaccessible to children from 0-12. Household medications are stored in the off limits bedroom which are locked an inaccessible to the children in care. Per recorded documentation Fire/earthquake drills were completed within the last six months. The fire extinguisher was serviced in September 2022.
Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The living room is the designated area for ill children in the child care.
Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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: EDWARDS FAMILY CHILD CARE
FACILITY NUMBER: 364841515
VISIT DATE: 10/03/2022
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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home has a fireplace. The fireplace was blocked off and was inaccessible. The home has central heating and air conditioning.

Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.

Outdoor: At the time of this inspection the outdoor area is divided into off limit and on limit areas. The on limit area was clean of hazards. There was a in ground pool in the back yard. he pool is surrounded by a 5’ wrought iron fence that is mounted on concrete. The bottom of the fence is no more than 4” from the concrete. The bars of the fence are no more than 4” apart. The gate swings away from the pool and is equipped with a self-closing, self-latching mechanism that is not more than 6” from the top of the gate. There are no items around the perimeter of the fence that would allow the fence to be climbable.

Per Licensee, there are no pets in the home.

CPR/First Aid expires 1.30.23 and mandated reporter training was current.



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.

LPA reviewed nine child files, the Licensees file, and two household members file. LPA advised the Licensee to utilize the LIC 311D and ensure all staff/household member files contain all required documentation.
Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings. .
The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Report continued on page three

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

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: EDWARDS FAMILY CHILD CARE
FACILITY NUMBER: 364841515
VISIT DATE: 10/03/2022
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Report continued from page two

The 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). State law prohibits baby walkers, bouncy seats, exersaucers, 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, 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 up to $500.00 maximum per day/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-and-resources/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.

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


LPA and Licensee discussed Unusual Incident Reports and the need to report within the required time frames.

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, Lydia Edwards.

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

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC809 (FAS) - (06/04)
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