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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700093
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:37:22 PM

Document Has Been Signed on 11/03/2022 03:37 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:BARRAZA FAMILY CHILD CAREFACILITY NUMBER:
367700093
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee Karina Barraza TIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee, Karina Barraza who guided analyst on a tour of the facility for the One Year Required inspection. This is a single story house with three bedrooms, two bathrooms, kitchen, dining room, living room, garage and backyard. Per License, the Living Room, Bedroom 2, kitchen and the bathroom located in the hallway are utilized for child care activities. The off-limits areas include: Bedroom 1 (primary bedroom), Bedroom #3 and the garage. The off limit areas of the home were inaccessible via locked doors. Upon arrival, LPA observed one infant and three preschool age children in care with the Licensee and staff 1 (S1) providing supervision. During the inspection four school age children arrived to the home. Currently living in the home is the Licensee, and adult 1 and two children (11 months and 3). All adults are associated and have eligible clearances. Current days and hours of operation are Monday thru Saturday 24 hours.
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 the locked garage. Sharp knives were stored in locked container stored on the kitchen counter. Household medications were stored in locked primary bedroom. Per recorded documentation Fire/earthquake drills are completed every six months. The last drill was completed in June 2022. The fire extinguisher was serviced in July 2022.
Safe and age appropriate toys, play equipment and materials were present inside the home. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes inside the home. 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. Bedroom 2 is the designated area for ill children in the child care. Per Licensee, there are zero firearms stored in the home. The home has a fire place. The fireplace was made inaccessible via a metal fireplace screen. LPA advised the Licensee to secure the metal screen to the surrounding wall to secure the barrier. The home has central heating and air conditioning. Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 367700093
VISIT DATE: 11/03/2022
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Report continued from page one

Bathrooms: Toilet, sink, faucet shower/tub were clean and operable. Zero chemicals or personal hygiene materials were located in the bathroom cabinets.
Outdoor: The outdoor space consists a covered patio, grassy area and a large climbing structure placed on wood chips. The outdoor play space was enclosed. There was a locked shed in the backyard. The climbing structure was secured to the ground and was placed on wood chips. LPA observed a wooden beam r surrounded the play structure. LPA observed the wooden beam was within two feet of the play structures climbing wall. LPA advised the Licensee to move the wooden beam away from the climbing wall to ensure a fall zone surrounds the climbing structure. LPA advised the Licensee to ensure the climbing structure meets the manufacturers installation requirements. A technical advisory notice was issued.

Per Licensee, there is one dog who resides in the home. At the time of the inspection there was a second dog who the Licensee was taking care of. Licensee stated the dogs do not interact with the child care children. Per Licensee the dogs are current on shots.

CPR/First Aid expires 03.20.2023 and mandated reporter training expires 9.1.23


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.

LPA reviewed six child files, files were complete and contained all required information. LPA also reviewed the Licensees, S1 and A1 files. LPA observed the files were missing documentation of the TB clearances. LPA reminded the Licensee of the requirement to maintain immunization documentation. LPA advised the Licensee to utilize the LIC 311D and LIC 126 to ensure all staff/household member files contain all required documentation.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings. .
The following were observed: Notification of Parents' Rights (PUB394), License, Emergency and Disaster Information (LIC610A). During LPAs record review, LPA observed the facility roster was not up to date. LPA advised the Licensee to update and maintain a current roster of the children enrolled in the family child care per regulation 102417(g)(8). Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 367700093
VISIT DATE: 11/03/2022
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Report continued from page two
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.

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.

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.htm


LPA and Licensee discussed Unusual Incident Reports and the need to report within the required time frames. Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 367700093
VISIT DATE: 11/03/2022
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Based on LPAs record review there was two technical violations issued today regarding records keeping.

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

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

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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