367700007-3-20-2026-12-CC-CALI-DSCQ2V-20260320114746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700007
Report Date: 03/20/2026
Date Signed: 03/20/2026 11:48:15 AM

Document Has Been Signed on 03/20/2026 11:48 AM - 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:	RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	367700007
ADMINISTRATOR/ DIRECTOR:	ADRIANA RODRIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 596-3130
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	03/20/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	ADRIANA RODRIGUEZ, Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:00 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 March 20, 2026, Licensing Program Analyst (LPA) Crystal Ali conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was granted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observed 5 children, 1 infant, and licensee providing care and supervision. Licensee reports she has 16 children enrolled. LPA observed a current LIC 9040. LPA has verified with Licensee that all adults currently in the home have received an approved criminal background clearance through Guardian. This is a large family childcare home. There are no IMS children. The operational childcare hours are Monday through Friday from 7:00am to 5:30pm. Staffing Ratio and Capacity: 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. This is a single story 3-bedroom, 2-bathroom home with kitchen, large living room, dining area, laundry room, backyard, and garage. Childcare is provided: living room and dining room. Off limit areas are three bedrooms (safety gate at hallway and locks on each door), one bathroom, laundry room (locked), garage (locked), storage shed (locked), and dog kennel on right side of house in backyard.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026

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 8

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)

Page: 2 of 8

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700007
	VISIT DATE: 03/20/2026

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

Per the Licensee, there is no smoking, no weapons, and no bodies of water on the premises. LPA observed one dog, one cat, and one bird on the premises. Licensee states all pets are current on their vaccinations.
Physical Plant: The daycare areas are living room, dining room, family room, kitchen, bathroom, and backyard. Licensee uses her cell phone for daycare business. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris. There is a fireplace /(safety latched) is inaccessible to children by glass screen and table and two high chairs blocking the glass doors. There are age-appropriate toys and equipment on the premises. The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept on top of the cubbies inaccessible to children. LPA observed a large play yard, two cribs, cubbies for children belongings, and children table (seats two) in living room. In the dining room LPA observed two tables, one bench, kitchenette, several toys, and books. LPA observed blind cords in the home inaccessible to children. LPA observed diaper changing station mounted on the wall in hallway next to garage on wall. LPA observed all outlets to have covers.
Napping: Children are provided naptime from 1:30pm-3:30pm. Licensee provides napping materials that are cleaned weekly. Napping area is the living room and dining room. LPA observed 12 cots in the dining room and two cribs in living room for infant. If children are ill then licensee states she will have them in the living room resting in on cot or chair until parents come to pick them up and the other children will be in the dining room.
Transportation: The licensee does provide transportation for school age kids. LPA observed a valid drivers license and car insurance.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026

LIC809 (FAS) - (06/04)

Page: 3 of 8

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700007
	VISIT DATE: 03/20/2026

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

Kitchen: The kitchen is off limits (safety gate observed). The kitchen was inspected and there were no hazardous or dangerous items. All the sharp utensils and knives were stored on the kitchen counter towards the back. The refrigerator/ freezer are both working. Detergents/cleaning compounds are kept under the kitchen sink with safety latch making it inaccessible to children. Medications are stored on top of cubbies in locked box, inaccessible to children. Licensee states there are no daycare children on medication and no children with allergies at this time. Licensee states she provides breakfast, lunch, snacks for the children. Licensee states she is enrolled the Ventura food program and that the representative came 1/2026.
Fire Extinguisher: The required fire extinguisher (2A10BC) is reading in green (1/21/26) and is located on wall in kitchen next to sliding glass door. Smoke and carbon monoxide detectors were found to be in compliance per Fire Marshall standards. Licensee states fire marshal came last to the home in May 2025. Licensee states that they told her to place exit signs above front and back door. Fire and Disaster drills are conducted at least every six-months, last completed 1/15/26 at 9:00am (earthquake drill) and 12/15/25 at 9:00am (fire drill).
Bathroom: The daycare bathroom is located in the hallway 2^nd door on the left. It has 1 sink, 1 toilet, 1 tub/shower. Bathroom is clean and in good repair.
Outdoor Space Activity: The outdoor area is the backyard. LPA observed shaded patio, one locked shed, RV trailer in the driveway (left side of backyard), swing set, basketball hoops, water table, play yard, with large play equipment with a slide and swings, tricycles, couches, several other toys, and basketball hoop. Licensee states that nobody lives in the RV trailer. LPA observed that the kennel gate does not have a lock to make area inaccessible to older children. Licensee states she has a tarp up but removed it. Licensee states she will place a lock on the gate.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026

LIC809 (FAS) - (06/04)

Page: 4 of 8

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700007
	VISIT DATE: 03/20/2026

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

Records/Documentation: LPA reviewed with facility representative the LIC 126, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Licensee was able to provide a valid Pediatric CPR/First Aid training valid until 8/10/26. Child Care Provider Mandated Reporter Training Certificate valid until 1/13/28. Licensee records are complete. LPA reviewed and observed children records (2). Children records are complete. LPA observed only one day 3/19/26 of safe sleep logs for C3. C3 has been enrolled since last year. Licensee states she has a file for all safe sleep logs that she keeps on all infants but she cannot find it. LPA issued a technical violation regarding past safe sleep documentation missing. Licensee had all the required posted documents: Facility License (LIC 203A, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148).
Criminal Record Clearance - Family Child Care Homes
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026

LIC809 (FAS) - (06/04)

Page: 5 of 8

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700007
	VISIT DATE: 03/20/2026

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

Safe Sleep - Family Child Care Homes
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-andresources/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 PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org – Family Child Care Homes
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Megan’s Law - Family Child Care Homes
During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026

LIC809 (FAS) - (06/04)

Page: 6 of 8

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700007
	VISIT DATE: 03/20/2026

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	No deficiencies cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Adriana Rodriguez.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026

LIC809 (FAS) - (06/04)

Page: 7 of 8