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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700080
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:17:48 PM

Document Has Been Signed on 01/27/2023 01:17 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:BRASSFIELD FAMILY CHILD CAREFACILITY NUMBER:
367700080
ADMINISTRATOR:BRASSFIELD, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 202-2829
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:License, Linda Brassfield TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee Linda Brassfield who guided analyst on a tour of the home for the One Year Required inspection. The child care space includes the Daycare room, family room, backyard, dining room, kitchen and the bathroom located within the day care room. The off limits areas are all three bedrooms, two bathrooms (located down the hallway), laundry room, and living room. The off limits areas were inaccessible via doors. Currently living in the home are the Licensee, and one adult. There is one assistant (S2) on file as well. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 6:00am to 6:00pm. When LPA arrived LPA observed three infants and one preschool age child in care with the Licensee providing supervision.

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. According to Licensee all cleaning products are stored in high inaccessible cabinets in the laundry room. Zero medications are currently at the home for child care children. According to the Licensee, household medications are stored in the inaccessible bedrooms and in a high inaccessible shelf in the pantry. Per recorded documentation Fire/earthquake drills was completed in January 2023. The fire extinguisher was purchased in 2022.

Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. The home has central heating and air conditioning. LPA observed a portable heater in the play room. LPA advised the Licensee that the portable heater could only be used with supervision and had to remain inaccessible to the child care children.

Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: BRASSFIELD FAMILY CHILD CARE
FACILITY NUMBER: 367700080
VISIT DATE: 01/27/2023
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Report continued from page one

Per Licensee, there is one fire arm in the home. Per LPA observations the fire arm was stored in accordance with regulations.

Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.

When LPA arrived to the childcare, LPA observed child 1 (C1), an infant wrapped in a blanket and falling asleep in a play yard. LPA observed a pacifier in the child's mouth with a pacifier clip attachment. LPA also observed a loose activity mat and loose toys in the play yard with the C1. This observation posed a potential risk to persons in care, therefore a type B citation was issued. Furthermore, LPA observed Child 2 (C2) an infant sitting up in the play yard playing with loose toys. LPA advised the Licensee to set up an alternate activity space for the infants to play so they are not forced to stay in the designated sleeping area when awake and engaging in play.

Outdoor: The entire back yard is on limits. LPA observed a covered patio, dramatic play house, tiny tikes play equipment. The backyard is enclosed with brick fencing. LPA observed the trees and bushes were maintained. Zero bodies of water are on the property. LPA observed a gasoline container with gas in the outdoor play area. The item was removed at the time of the inspection and zero child care children were observed in the outdoor play area during the inspection. LPA reminded the Licensee to continually monitor the outdoor space to ensure all items which could pose a danger to children are inaccessible.

Per Licensee, the family has one dog. Per Licensee the dog does interact with the child care children.

CPR/First Aid expires 09/17/24 and mandated reporter training expires on 9/2/2024.



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.

Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
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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: BRASSFIELD FAMILY CHILD CARE
FACILITY NUMBER: 367700080
VISIT DATE: 01/27/2023
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Report continued from page two

LPA reviewed six child files, the Licensees file and one assistants file, staff 1 (S1). Based on LPAs record review three of six child files were missing immunization records (C1, C2, C3). A type B citation was issued, as this poses a potential risk. Per LPAs record review of the Licensee file and S1 file was missing immunization records, a type B citation was issued, as this poses a potential risk. Furthermore, per LPAs record review and statements from the licensee S1 and S2 have not completed the mandated reporter training as required. A type B citation was issued, as this poses a potential risk.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep.
The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A). Based on LPAs review of the roster, the document was missing the information for five enrolled children and was missing the Physician Name and Phone number for all the children. Therefore the roster was not current, a technical advisory notice as issued.

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



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 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.

Report continued on page four
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
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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: BRASSFIELD FAMILY CHILD CARE
FACILITY NUMBER: 367700080
VISIT DATE: 01/27/2023
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Report continued from page three

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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

Based on LPAs record review there were three technical advisory notices issued today and four type B citations, refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Linda Brassfield

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/27/2023 01:17 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 01/27/2023 at 12:01 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: BRASSFIELD FAMILY CHILD CARE
FACILITY NUMBER: 367700080

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed a child wrapped in a blanket and falling asleep in a play yard. LPA observed a pacifier in the child's mouth with a pacifier clip attachment. LPA also observed a loose activity mat and loose toys in the play yard with the infant. This observation poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2023
Plan of Correction
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All items were removed from the play yard during the inspection. Licensee will review the safe sleep regulations and videos. Licensee will send LPA written documentation that the safe sleep training has been completed
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of three staff member (S1) and (S2) have not completed the mandated reporter training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2023
Plan of Correction
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Per Licensee, the staff members will complete the required training. Documentation will be provided to the Department.
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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023


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Document Has Been Signed on 01/27/2023 01:17 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 01/27/2023 at 12:01 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: BRASSFIELD FAMILY CHILD CARE
FACILITY NUMBER: 367700080

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the Licnesee and S1 files did not contain proof of the required immunization's (TDAP, Measles, and Influenza) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
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Per Licensee, immunization documentation will be added to the staff files.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in three of six child files reviewed did not contain documentation of immunization's, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2023
Plan of Correction
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Per Licensee, copies of the children immunization records will be obtained. Licensee will review all child files and ensure all required documentation is within the files.
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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023


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