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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844474
Report Date: 09/18/2023
Date Signed: 09/18/2023 01:31:50 PM


Document Has Been Signed on 09/18/2023 01:31 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:GIEBE FAMILY CHILD CAREFACILITY NUMBER:
364844474
ADMINISTRATOR:GIEBE VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 565-8302
CITY:PHELANSTATE: CAZIP CODE:
92371
CAPACITY:14CENSUS: 0DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Victoria GiebeTIME COMPLETED:
01:45 PM
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On 9/18/2023, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required annual inspection at the Giebe Family Child Care Home. Upon arrival, the LPA met with the licensee, Victoria Giebe, who guided the LPA on a tour of the facility. Individuals that reside in the home include 4 adults (licensee and 1 adult child) and 2 sons (Ages 14 and 11). Pre Guardian, her assistant Marci Clause was not associated with this FCC facility. Marci does not have her fingerprint associated with #367750060 and 367750061.
This is a large family childcare facility. The hours of operation are Monday through Friday, 6:00 a.m. to 6:00 p.m. During the inspection, LPA observed 0 childcare children. Due to the power outage, the facility is closed today (9/18/2023). Per the Licensing Information System, annual facility fees were current. Incidental Medical Services (IMS) were discussed. Per the licensee, she does have a child who needs IMS at this time.
The home is set up as follows: This is a two-story home with 4 bedrooms, 3 bathrooms, a kitchen, a living room, formal dining, a family room, a playroom, and a garage. The following areas are used for Daycare:
Daycare is provided in the family room/classroom, dining room, 1 bathroom, and backyard are utilized for the family childcare. The off-limit areas of the home are 4 bedrooms, a living room, 2 bathrooms, a kitchen, a Front, an outside gated area, and a garage.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474
VISIT DATE: 09/18/2023
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There is a barricade present on the bottom and top staircase; the licensee is reminded that barricade(s) must remain in place during Daycare hours if there are children under 5 years old in care.
· Playroom Room/Dining Room/ Family Room: In the playroom (Family room), the designated playroom, there are adequate age-appropriate toys, books, games, and napping mats/hygienic diaper changing equipment. PA observed age-appropriate toys and furniture for the children. There are games and books on the premises of this facility. The carpets and other materials were observed to be in good condition.
· Children's bathroom: Children will use the bathroom down the hall to the left. The bathroom was the tour. The bathroom was clean, sanitized, and in good repair. The toilet was inspected, and the sink/toilet is in operable condition. The toilet and faucets are clean, safe, and operable. The bathroom was observed to be free and clear of hazardous items.
Off limited areas: Upstairs bedrooms and bedrooms. Backyard (Declaration): The backyard was inspected; the children will not use the outdoor backyard until the area is clean and fix. The backyard is gated all around. The outdoor play area was observed to be free of hazards and loose and sharp parts. There is a grass and concrete area for active play. There are tiny tots, swings and slides, a house (with padding), a sandbox, and a water table. The slides is broken and unsafe for the childcare children. Kitchen/Dining Room: The kitchen was inspected to ensure dangerous items were inaccessible to children (Safety latches). All sharp utensils, poisons, and medications are unavailable to children in the kitchen, with child safety latches on cabinet doors and drawers. Sharp knives are kept in a butcher block in the gated kitchen.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474
VISIT DATE: 09/18/2023
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Other:
· AC/Heating Unit / Swamp Cooler unit was observed. The AC/Heating Unit is located on the right side of the home and is inaccessible to children via barrels blocking access to the AC unit.
· Bodies of water: Pre the licensee, there were no bodies of water in the home. There is a decorative water fountain that has no water.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Food: The licensee is enrolled in the Food program. The licensee will provide Breakfast, lunch, and snacks.
· Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green and located in the laundry room (6/23), inaccessible to children. It meets standards established by the State Fire Marshall.
· Fireplace: The fireplace was observed in the living room and is screened to make it inaccessible to the children.
· Hanging window blind cords: The cords are accessible to children.
· Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in the office.
· Medications and cleaning solutions: Detergents/cleaning compounds are in the laundry room and inaccessible to the children. Medications are in the wall with lock.
· Napping: Children will nap in designated areas (Family room) with adult supervision. LPA observed 6 cots and 12 mats in the closet.
· Pets: No pets
· Phone service: There is a working landline or cell phone.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474
VISIT DATE: 09/18/2023
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·Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· The First Aid kit is in the key-locked closet, inaccessible to children. The First Aid Kit was observed to be complete with supplies and a first aid manual.
· Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license, valid vehicle insurance, and vehicle registration.
· Weapons or Firearms: Per the licensee, there are No Firearms at the facility at this time. LPA does not observe any firearms.
LPA reviewed the following Documentation:
· Child files: LPA observed that 5 children's files and the records were found to be in order.
· CPR/First Aid: LPA observed that the licensee has current Pediatric CPR and First Aid Training with an expiration date (of 09/24).
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and performed on 01/20/2023.
· Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP). The licensee and her assistant provided a written statement declining the influenza vaccination.
· Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed 2 infants have LIC 9227, and the Sleeping log is also in each infant's file,
· The licensee posts all required information.
· Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 3/13/24.
· Staff Personnel File: LPA observed 2 staff information. Assistant #2 does not have her fingerprint associated with the Family Child Care.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474
VISIT DATE: 09/18/2023
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The following information was discussed with the licensee:
o Mandatory Forms for the children's and assistant files.
o The licensee is reminded that 100% supervision is required for children at all times.
o Capacity, Roster requirements, and Documentation requirements for disaster drills (fire and earthquake).
o Licensee was made aware that it is their responsibility to know the regulations and anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Licenses were advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B.
o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o A baby walker shall not be allowed on the premises of a family childcare home in accordance with Health and Safety code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucers, and other items that fall into that category.
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o 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).
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474
VISIT DATE: 09/18/2023
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o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
o To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
o Licensee [or facility representative] 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.
o LPA discussed the safe sleep regulations with the licensee [or facility representative] 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 the licensee [facility representative] 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.
o A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474
VISIT DATE: 09/18/2023
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o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.

Deficiencies cited: (See LIC 809D). The following Type A deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

Exit interview conducted and report was reviewed with the licensee, Victoria Giebe.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/18/2023 01:31 PM - It Cannot Be Edited

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: GIEBE FAMILY CHILD CARE
FACILITY NUMBER: 364844474

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. During today's inspection, LPA observed the assistant Marci Clause's fingerpring is not associated with the facility or not cleared with the Guardian, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2023
Plan of Correction
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on 9/18/2023, the facility was not operating due to the power outage in the area. The licensee agreed the assistant Marci Clause will not return to the Giege Family Child Care Home until her fingerpring is clearned.
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 YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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