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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843262
Report Date: 11/17/2025
Date Signed: 11/17/2025 04:57:20 PM

Document Has Been Signed on 11/17/2025 04:57 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:DE LA PAZ FAMILY CHILD CAREFACILITY NUMBER:
364843262
ADMINISTRATOR/
DIRECTOR:		KARINA DE LA PAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 486-1459
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 13DATE:
11/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Facility Representative Paula Acevedo and Licensee Karina De La PazTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On November 17, 2025, at 03:30 p.m., Licensing Program Analyst (LPA) Kendal Zirbes met with Facility Representative Paula Acevedo. The purpose of the inspection was to conduct an unannounced annual/random inspection. LPA disclosed the purpose of the inspection to the Facility Representative. When LPA arrived to the facility, facility representative Paula Acevedo and adult 1 (A1) were present with 11 children all over the age of two. LPA was informed the Licensee was away conducting school pick ups. Licensee arrived at approximately 03:40 with two additional school age children. Based on LPA observation, the family child care was meeting the capacity/ratio requirements.
Physical Plant: This is single story home with three bedrooms, two bathrooms, kitchen, dining area, living room, day care room, laundry room, front/backyard and detached garage. Per Licensee the kitchen, dining area, living room, day care room, hallway bathroom and backyard are utilized for the family child care activities. Per licensee off-limit areas of the home are all three bedrooms, the master bathroom, laundry room, front yard and detached garage. The off limits areas were inaccessible via child safety gates, and key locked door knobs. Currently living in the home is the Licensee, two adults and one minor child. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 5am to 8:00pm. The Licensee is approved for less than 24 hour care per family/child. 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 all cleaning products are stored in a cabinet in the classroom and under the kitchen sink. Both cabinets were equipped with child safety locks. Sharp knives were stored in high kitchen cabinet which was equipped with child safety locks. Household medications are stored in the off limits master bedroom. Per recorded documentation Fire drills are completed every month. The fire extinguisher was serviced in March 2025. Report continued on page two
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DE LA PAZ FAMILY CHILD CARE
FACILITY NUMBER: 364843262
VISIT DATE: 11/17/2025
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Report continued from page two

Safe and age appropriate toys, play equipment and materials were present. The home has smoke detectors and carbon monoxide detectors. The combination smoke/carbon detector were tested during this inspection and found to be in working order. 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 dining room is the designated area for ill children in the child care.
Per Licensee, there are zero firearms stored in the home. The home has a fireplace which is blocked by a glass screen therefore the fire place is inaccessible to the children in care.
Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. A changing area is in the living room of the home.
Outdoor: The backyard is split level and is completely fenced. The backyard has a grass area and a concrete area. At the time of this inspection there were zero bodies of water on the premises. The outdoor play area was inspected was observed to be free of hazards.

Per Licensee, the family has one dog who does not interact with the child care children.

Due to time constraints LPA was unable to complete the entire inspection.

Based on LPAs observations 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 Karina Del La Paz.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
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