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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700011
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:26:55 PM

Document Has Been Signed on 02/16/2023 03:26 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:KERSH, VANESSA FAMILY CHILD CAREFACILITY NUMBER:
367700011
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Licensee, Vanessa Kersh,TIME COMPLETED:
03:35 PM
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Licensing Program Analyst's (LPA) Maddox met with Licensee, Vanessa Kersh, who guided analyst on a tour of the facility for an unannounced Annual 1-yr inspection. This is a single story 3 bedroom, 3 bathroom home with Kitchen/Dining, Formal Dining Room, Living Room, Playroom (Mudroom), Enclosed Patio and Garage. There is a spa in the back yard that was locked and inaccessible to children. Family members residing in the home include two adults (Licensee and Spouse), who were present during inspection. Days/hours of operation will be Monday through Friday from 6:00 AM to 6:00 PM or later if needed.

Main care is provided in Bedroom #1, Enclosed Patio and Playroom. Children use the Bathroom #1. Off limit areas include the Bedroom #2 and #3, Bathroom #2 and #3, and the Garage/Laundry area (all under key lock). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating (central) and ventilation.

Backyard off limits (declaration provided). The backyard is completely fenced. Spa is locked. There are two dogs on the premises.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KERSH, VANESSA FAMILY CHILD CARE
FACILITY NUMBER: 367700011
VISIT DATE: 02/16/2023
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Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

A sampling of children's records were reviewed, all files contained required documentation. LPA observed working smoke detectors and carbon monoxide detectors in the home, fully charged fire extinguisher, and first aid kit. Medicines and cleaning solutions are kept in a locked cabinet in the kitchen. CPR and First Aid training card exp 1/24, Mandated Reporter training certificate expires 7/2023.

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.html

An exit interview was conducted and a copy of this report was read and provided to the Applicant Vanessa Kersh.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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