364844410-5-10-2023-12-CC-KZIS-CRPSHD-20230510135323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364844410
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:53:36 PM

Document Has Been Signed on 05/10/2023 01:53 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:	FARAH FAMILY CHILD CARE		FACILITY NUMBER:	364844410
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 1	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Licensee Wafa Farah		TIME COMPLETED:	02:10 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 May 10, 2023 at 11:18 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Required One year inspection and a case management inspection to assess the home for a capacity increase. LPA met with Licensee, Wafa Farah. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. One child care child was present in the facility during this inspection. The licensee is requesting to provide care for a Large family childcare home (FCCH) with a capacity of 14 children. Fire clearance was granted on 4/27/2023. The facility is a two bedroom, two bathroom house, with a toy room, detached garage, front yard and back yards. Licensee accompanied LPA inside and out of the facility during this inspection. Per Licensee the living room, toy room, first hallway bathroom, and the front yard are utilized for the family child care activities. The off limits areas of the home include all bedrooms, the second hallway bathroom, detached garage and the back yard. The off limits areas were inaccessible via child safety gates, and locked doors. Currently living in the home is the Licensee and adult 1. Licensee is requesting to provide care for 24 hours a day seven days a week. Indoor: (On limits) Living room: This area was furnished with two couches, television, and table. Toy room: This area had a television, board games, stuff animals, puzzles, books and black board. Bathroom 1: Located off the hallway. The bathroom was equipped with a toilet, sink, and shower. No hazardous items were in the bathroom at the time of this inspection. The bathroom was clean and orderly. Outside: The front yard is the on-limit outdoor space. LPA observed a play set with three swings and a slide placed on grass. The play set was secured to the ground. The outdoor space is fully enclosed by a five foot fence. Napping equipment: LPA observed one play yard and seven mats. The children also rest on the couches in the living room. Licensee stated they are willing to purchase additional napping equipment if necessary to met the needs of the children in care. Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 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: FARAH FAMILY CHILD CARE	FACILITY NUMBER: 364844410
	VISIT DATE: 05/10/2023

NARRATIVE

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Report continued from page one

Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Weapons or Firearms: Per Licensee, there are no firearms in the home.
Cleaning compounds: Stored in a locked closet in the off limits kitchen.
The smoke detector and a carbon monoxide detector: located in the hallway of the home. The home has a pull down fire alarm in the entrance way.
Fire extinguisher (2A10BC) There was a fully charged fire extinguisher (2A10BC); which meets fire marshal standards.
Pet: The family has one dog. Per Licensee, the dog does interact with the child care children. The pet is current on licensing and shots.
Fireplace: The home does not have a fireplace. The home has central heating and air conditioning.
Knives/Sharp items: Stored in the off limits kitchen. The kitchen was inaccessible via a chid safety gate. The knives were stored in a high shelf in the kitchen
Off Limit areas:
Bedroom #1 (Master Bedroom) (Off limits): Located off of the hallway. The bedroom was furnished with bed, and personal belongings. The door leading to the master bedroom was equipped with key lock.
Bedroom #2: (Off limits): Located off of the hallway. The bedroom was furnished with bed, and personal belongings. The door leading to the bedroom was equipped with key lock.
Bathroom #2: (off limits) Located off the hallway (second door on the right). The bathroom was equipped with a toilet, sink, and shower. No hazardous items were in the bathroom at the time of this inspection. The bathroom was clean and orderly. The bathroom door is equipped with a key lock.
Detached Garage (Off limits): Located in the backyard. The garage held household items such as tools, and household supplies. The garage was inaccessible via a locked door.

LPA reviewed the Licensee file, one household members file and six child files. All required forms were within the files at the time of this inspection. Per LPAs review the Licensee CPR/First Aid expires 05.27.2024 and mandated reporter training expires on 06.22.2024.

Report continued on page three

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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: FARAH FAMILY CHILD CARE	FACILITY NUMBER: 364844410
	VISIT DATE: 05/10/2023

NARRATIVE

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Report continued from page two

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

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 the large family home capacity regulations. LPA also discussed the personal requirements for the new staff person.

Report continued on page four

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 2 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: FARAH FAMILY CHILD CARE	FACILITY NUMBER: 364844410
	VISIT DATE: 05/10/2023

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	Report continued from page four Based on LPA observations, and record review there were zero deficiencies cited today. As a result of this inspection, the home does meet Title 22 Regulations. Capacity increase is pending final approval from the Licensing Program Manager. Exit interview conducted and report was reviewed with the licensee Wafa Farah.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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