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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700109
Report Date: 11/04/2024
Date Signed: 11/06/2024 04:06:02 PM

Document Has Been Signed on 11/06/2024 04:06 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MATHEU FAMILY CHILD CAREFACILITY NUMBER:
367700109
ADMINISTRATOR/
DIRECTOR:		MATHEU, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 983-5320
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
11/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:31 PM
MET WITH:Sandra MatheuTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On November 4, 2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced annual/random inspection at Matheu Family Child Care. Upon arrival, LPA Heath was greeted by the licensee, Sandra Matheu, who provided a facility tour. The home is occupied by 4 adults (the licensee, her husband, and 2 adult sons). 5 young children and on 4 infant were present with the licensee and assistant during the inspection. The licensee stated that the facility operates Monday through Friday from 6:00 a.m. to 6:00 p.m. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children currently require IMS.
The home is set up as follows: It is a one-story with three bedrooms and two bathrooms, a kitchen/dining room, a living room, family room, laundry room, and a garage. There is a above pool: bodies of water are on the off limited area. The home was inspected for safety, comfort, cleanliness, phone service, and ventilation. The house has central heating and air conditioning, and all windows have intact screens free of cracks, bugs, or debris.
Main Area: Childcare is primarily provided in the living room, bathroom #1, and backyard (outdoor play area). Children use the bathroom in the hallway to the left. They have access to the dining, living, and family rooms. Off-Limit Areas: Off-limit areas include all bedrooms, the kitchen, bathroom #2, the laundry room, and the garage."
Living Room: LPA observed age-appropriate toys and furniture in the designated childcare areas. There is a table with eight child sized chairs and multiple plastic storage bins containing games and toys. The facility also provides books and games for the children. Educational mats were placed on the floor in good condition. An adult sized couch is present, and a TV shows educational videos to the children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
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Children's Bathroom (#1): The bathroom was inspected, and the sink and toilet were operable. The toilet and faucets were clean and safe. The medication cabinet has many personal items. They were not secured. The licensee removed all the items and made them inaccessible to the children.
Kitchen (Safety Gate—off-limit): The kitchen was inspected. Hazardous items were stored out of children’s reach using child safety latches. Sharp utensils, poisons, and medications were inaccessible to children, and sharp knives were stored in a butcher block. In addition, there are a knives set in the kitchen counter. However, the safety gate was open during the inspection, which allowed children access to the kitchen. LPA also observer medication in the kitchen area which may be accessible to the children.
Backyard: The fully enclosed backyard was inspected for outdoor play, and no hazards, loose objects, or sharp items were observed. LPA noted a swing set, toy houses, and slides. An above-ground pool was present; however, the fence around it is not five feet high, with the bottom of the fence between two to four inches from the ground. The fence is designed to prevent climbing and has gates that swing away from the pool. Both gates are self-closing, but only one has a self-latching device positioned within six inches from the top. The pool currently does not meet Title 22 regulations. The licensee has signed a declaration to make the backyard off-limits until the pool complies with Title 22 requirements.
Additional Information:
The AC/Heating unit is located on the right side of the home and is blocked by barrels, making it inaccessible to children. There are no bodies of water in the house. All unused electrical outlets are plugged and inaccessible to children. The licensee, enrolled in the Food Program, provides breakfast, lunch, snacks, and sometimes dinner.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
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A 2A10BC fire extinguisher in the kitchen and reading in the green meets State Fire Marshall standards and is inaccessible to children. There is no fireplace, and all window blind cords are out of children's reach. If a child shows signs of illness, they will be isolated in bedroom #1.
Cleaning compounds are stored in an off-limits laundry room, and medications are kept in an off-limits bedroom, both inaccessible to children. Children nap in designated areas with adult supervision, and 9 mats and 2 cribs were observed in a closet. The home has a working phone line.
Smoke detectors and carbon monoxide devices were tested and found to be operable. A First Aid kit with supplies and a manual is kept in the kitchen closet, out of children's reach. The licensee does not provides transportation. The licensee confirmed that there were no firearms at the facility, and none were observed during the inspection.
Documentation Review:
Child Files: LPA reviewed eight children's records and all necessary licensing documents were observed in the files.
Infant Sleeping Plan (LIC 9227) and Sleeping Log: Two infants have LIC 9227 forms, and their sleeping logs were in place, in accordance with the Safe Sleep Regulation.
Staff Personnel File: During the inspection, LPA reviewed 1 staff file, which included LIC 508, LIC 9052, immunization records, a TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. All required documents were in place.
Immunization Records: The licensee and her assistant have up-to-date immunizations for MMR and DTaP, and both have submitted written statements declining the influenza vaccine.
Criminal Record: According to the Guardian, all adults living and working in the facility have criminal record clearance.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
NARRATIVE
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CPR/First Aid: LPA verified that the licensee holds current Pediatric CPR and First Aid certifications, which expire on 09/2025. The licensee also completed one hour of nutrition training and eight hours of Preventive Health and Safety Training.
Mandated Reporter Training: The licensee completed the online mandated reporter training at www.mandatedreporterca.com, which expires on 10/27/2026.
Facility Fees: According to the Licensing Information System, the annual facility fees are current.
Fire/Disaster Drill: The licensee conducts fire and disaster drills every six months, with the last drill documented on 10/16/2024.
Required Postings: LPA observed that the licensee (does/does not) have the Facility License, Emergency Disaster Plan, Earthquake Preparedness, and Parents' Rights Poster displayed as required.

The following information was discussed with the licensee:
o A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
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o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. 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
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o 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 childcare home where children are present (24/7 ban).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
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ü LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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.
ü Licensee [or facility representative] 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.
ü IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS: 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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
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ü IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: 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/.
ü Centers and Family Child Care Homes Licensee [or facility representative] 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.
ü 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.
ü Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.
ü 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-carelicensing/ inspection-process.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109
VISIT DATE: 11/04/2024
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Deficiencies cited: (See LIC 809D). The following Type A deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes: (List of the deficiencies)

An exit interview was conducted, and the report was reviewed with the licensee, Sandra Matheu.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/06/2024 04:06 PM - It Cannot Be Edited


Created By: Carol Heath On 11/04/2024 at 01:52 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: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 367700109

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. During today's inspection, the LPA observed above ground pool without 5 feet fences and self-closed and self-latch divice, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/04/2024
Plan of Correction
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The licensee signed the declaration to make the backyard off-limeted for the childcare children.

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:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


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