364842907-10-4-2023-12-CC-JTAO-CWARH7-20231004130151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364842907
Report Date: 10/04/2023
Date Signed: 10/04/2023 01:28:06 PM

Document Has Been Signed on 10/04/2023 01:28 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	364842907
ADMINISTRATOR:	PEREZ, PETRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(442) 285-7175
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92394
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	10/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Petra Perez, Licensee		TIME COMPLETED:	01:20 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	On 10/04/2023 Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee Petra Perez, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 4 bedroom, 3 bathroom home with kitchen/dining, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 1 infant and 5 preschool children in care, along with assistant #2. Assistant #1 came shortly after with another school age child. Family members residing in the home include 2 adults (licensee and licensee's husband) and 2 minor children. Facility operation are Monday-Friday for less than 24 hours a day. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in the living room. Children use the bathroom near the living room area. Children have access to the living room, dining room area, and garage(is used for activities only). Off limit areas include all bedrooms, bathrooms #2 and #3 (upstairs), and laundry room(upstairs-off limits). LPA observed the upstairs entrance to be fully barricaded by a safety gate. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety lock), medicines (upper kitchen pantry) and hazardous items (sharp knives in kitchen drawer with safety lock) that can pose a danger to children. LPA did not observe a fireplace in the home. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (3A40BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed. There is a designated area for ill children as necessary near front entrance. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 364842907
	VISIT DATE: 10/04/2023

NARRATIVE

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Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster Drill was completed on 05/15/2023.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Licensee currently has a food program. Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in the living room area.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). LPA observed the outdoor play area fully covered with turf grass. There is no body of water. There is an outdoor air conditioner barricaded by a chain link fence. LPA observed age appropriate toys and play structures. Per licensee, there are no pets on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 04/13/2025. Mandated Reporter expires 06/06/2025. There are no window cords accessible to children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 364842907
	VISIT DATE: 10/04/2023

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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Safe Sleep Log. Licensee stated currently has child care insurance.

Licensee Perez 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 Perez 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.

No deficiencies have been cited at this time.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Petra Perez, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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