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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700130
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:25:07 PM

Document Has Been Signed on 12/17/2021 12:25 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:LAGARDE FAMILY CHILD CAREFACILITY NUMBER:
367700130
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
12/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Liliana LagardeTIME COMPLETED:
12:40 PM
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Licensing Program Analyst's (LPAs) Thompson-Miller and Montoya met with Liliana Lagarde who guided analyst's on a tour of the facility for an One Year Required inspection. Licensee present during inspection, along with 2 children (1 preschool, 1 infant). This is a single story 3 bedroom, 2 bathroom home with kitchen/dining, living room/child care, laundry room and garage. There is a Trampoline in the backyard (off limits to children in care, Declaration provided during this inspection). There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (licensee, licensee spouse) and three children. Days and hours of operation: Monday through Friday 7:00 AM to 4:30 PM (updated during the inspection). Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room (at entrance). Children use the bathroom in hallway on the left. Off limit areas include all Bedrooms #1, #2 and #3, bathroom #2, laundry and garage (key lock). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room), medicines (off limits bedroom) and hazardous items (cabinet, key lock) that can pose a danger to children. Sharp knives are in the upper cabinet of the kitchen. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. The fireplace is screened. There is a designated area for ill children as necessary in living room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and updated to add Trampoline (off limits gated area), there is working telephone (landline, cell). Per Licensee no one smokes in the home.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2021
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: LAGARDE FAMILY CHILD CARE
FACILITY NUMBER: 367700130
VISIT DATE: 12/17/2021
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Bathroom: Shower is free of hazards (child care bathroom). The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean and operable.
Kitchen: The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in laundry area (off limit). No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, dinner and snacks will be provided.

Outdoor: Per Licensee the backyard is off limits and will notify LPA (licensing when remove from off limits). The backyard is completely fenced and there is a gate on left side and the right side has a wrought iron fence. No pets. There is a Trampoline (Declaration provided).

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expired 12/14/21. Licensee registered for 01/25/22 and will provide a copy to Child Care Licensing upon completion. Mandated Reporter 02/17/2022. 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.
Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep and Lead Poisoning flyer's. Licensee stated currently does not have child care insurance.

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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: LAGARDE FAMILY CHILD CARE
FACILITY NUMBER: 367700130
VISIT DATE: 12/17/2021
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The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is his/her/their 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; Regulation prohibits the smoking of any kind during the operation of the day care. Per Licensee no on smokes in the home.

Licensee advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov).

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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: LAGARDE FAMILY CHILD CARE
FACILITY NUMBER: 367700130
VISIT DATE: 12/17/2021
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Prior to making alterations or additions to a family child care home or grounds, the Licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. 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.


Documents Provided and or Discussed: COVID-19 posters, LIC311D, Lead Flyer, Safe Sleep, Seat Belt Safety.
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 [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 Cheryl Miller 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.


No deficiency.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Liliana Lagarde. This report was read and provided to Licensee Liliana Lagarde on this date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC809 (FAS) - (06/04)
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