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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700073
Report Date: 04/28/2026
Date Signed: 04/28/2026 12:54:27 PM

Document Has Been Signed on 04/28/2026 12:54 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:GUERRERO FAMILY CHILD CAREFACILITY NUMBER:
367700073
ADMINISTRATOR/
DIRECTOR:		GUERRERO, ORFAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 515-6640
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 5DATE:
04/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Orfa Guerrero, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
NARRATIVE
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On April 28, 2026, at 9:50 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Guerrero Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA met with the licensee, Orfa Guerrero. LPA Del Mundo stated the reason for the inspection. LPA was granted access to the facility. The LPA provided copies of the LIC 126 Entrance Checklist Form, Licensee guided the analyst on a tour of the day care areas. The day care takes place in the following area of the home: living room, dining room, bathroom #1, bathroom #2, and backyard (outdoor play area). Licensing fees are current. Licensee states the day care hours of operation are 23 hours, seven days a week. During this visit, LPA observed five children including the licensee’s own grandchild and one assistant in the facility.

Physical Plant: 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. Licensee also requested to use family room as part of the day care area. Fire clearance was granted on April 23, 2026, and the family room is ready for use. LPA observed couches, tables, chairs, cubbies, book rack, books, play pen, puzzles, drawing board, sand boxes, and other toys in the family room. The smoke detector and carbon monoxide detector are in operable conditions (tested at 10:28 a.m.). The facility has a 3-A:40-B:C type of fire extinguisher. Licensee stated that she owns no firearms and no one smokes in the facility. The kitchen has child safety baby gate. LPA observed cleaning products are stored in the lower kitchen cabinet under the sink, and the cabinets have child safety locks. Other cleaning products are stored in the garage (Off-limits). LPA observed knives are stored inside the kitchen drawers with child safety latch. LPA also observed household medications are stored inside the kitchen drawers with child safety lock.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2026
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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Document Has Been Signed on 04/28/2026 12:54 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 04/28/2026 at 12:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 367700073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above by failing to provide the assistant 1’s Pertussis and Measles vaccinations, which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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The licensee will email copies of the assistant 1’s Pertussis and Measles vaccination to LPA.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above by failing to provide child 2 immunization records which posed a potential risk to the Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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Licensee will send copies of the immunization records for child 2 to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Joselito DelMundo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/28/2026 12:54 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 04/28/2026 at 12:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 367700073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above by failing to provide child 5’s LIC9227 which posed a potential risk to the Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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Licensee will send a copy of the signed LIC9227 for child 5 to LPA.
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.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Joselito DelMundo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2026


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: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 367700073
VISIT DATE: 04/28/2026
NARRATIVE
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The facility is a one-story house. There is a fireplace in the living room of the facility, and it is covered with an iron fence. Cubbies for storing other toys also blocked the fireplace. The home has central heating and air conditioning units.
Safe and age-appropriate toys, tables, chairs, and other play equipment were observed during the inspection. LPA observed four sleeping cots. Per licensee, licensee has six sleeping cots.
LPA observed the first aid kit stored inside the closet next to the living room.
Bathroom 1 and 2: Toilet, sink and faucet were clean and operable. LPA did not observe medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care. LPA observed shampoos, mouthwash, metal pimple remover, and nail cutter inside the medicine cabinet, shower area, and in the lower cabinet. LPA observed the lower cabinet in bathroom 1 has broken safety lock. LPA advised the licensee to fix the broken lock in the cabinet. During this visit, the licensee removed the shampoos, mouthwash, metal pimple remover, and nail cutter that were observed and made the items inaccessible.
Bedroom 1: Bedroom 1 is the napping room. LPA observed three cribs, 1 toddler bed, four sleeping cots, diaper changing table, pillows and sheets inside the bedroom. Per licensee, the pillows and the diaper changing table are not being used. Licensee use the diaper changing table that is located next to the living room. Licensee will use bedroom 1 as an isolation area for children with symptoms of illness and parents are called immediately.
Outdoor: The facility has no body of water on the premises. LPA did not observe body of water on the premises. The outdoor has dirt, turf grass, concrete, and rocks.
LPA observed swing set, wooden toy house with slide and tunnel, swing set, climber, sand box, tricycles, rideable toy cars, and an empty wading pool that is overturned. LPA also observed four dogs on the side of the family room that is gated, and the dogs also do not interact with children.
At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov
Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 367700073
VISIT DATE: 04/28/2026
NARRATIVE
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LPA reviewed children’s files, licensee, and assistant’s files. Based on records review, Child 2 has no immunizations on file. Also, Child 5 has no LIC9227 Individual Infant Sleeping Plan on file. Licensee was advised to send the forms to via email.

LPA reviewed the licensee and assistant’s files. Based on records review, licensee and assistants have current and mandated reporter training and pediatric CPR/First Aid training. Licensee and assistant 2 have proof of immunizations against Measles and Pertussis. The license and assistants have TB test on file. Assistant 1 does not have proof of immunizations against Measles and Pertussis. Licensee was advised to send copies of Assistant 1 immunizations to LPA via email.

Licensee conducted fire and disaster drills on March 24, 2026, at 10:00 a.m. and 11:00 a.m. Based on the facility roster, licensee has seventeen children enrolled in the day care.

Licensee and other adult living in the home have received criminal record clearance.

The following was discussed with the licensee:

The licensee was reminded that 100% supervision is required at all times to children in care. The licensee was made aware that it is his/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.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). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category. Licensee was advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission. 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.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

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 367700073
VISIT DATE: 04/28/2026
NARRATIVE
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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/.

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. 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


The licensee was informed that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com. New employees shall have 90 days from date of employment to complete training as required.Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changes, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.Lead Flyer Requirement Health and Safety Code 1596.7996 mandated that effective January 1, 2019, CCC's and FCCH's are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 367700073
VISIT DATE: 04/28/2026
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



During the exit interview the licensee, Orfa Guerrero, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM to 5:00 PM.

Type B deficiencies were cited at this time. An exit Interview and discussion of observations were conducted with the licensee.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Orfa Guerrero.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC809 (FAS) - (06/04)
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