<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700142
Report Date: 06/19/2024
Date Signed: 06/19/2024 03:29:29 PM

Document Has Been Signed on 06/19/2024 03:29 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:RUBALLOS FAMILY CHILD CAREFACILITY NUMBER:
367700142
ADMINISTRATOR/
DIRECTOR:		LESLIE VERONICA RUBALLOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 809-2153
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
06/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:22 AM
MET WITH:Vivian SagastumeTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 19, 2024, Licensing Program Analyst (LPA) Kris Diaz, conducted an unannounced Annual/Random Inspection. LPA met with Assistant, Vivian Sagastume who granted access and guided LPA on a tour of the home. People who reside in the home are the Licensee, licensee’s spouse, Licensee’s brother, Licensee’s sister-in-law, and licensee’s brother’s minor children (2, 13) and licensee's minor children (7,12). All adults living in the home are live scanned and have TB skin test on file. The large family childcare home operates 23 hours per day 7 days per week. Licensee was advised that a staff member must always be awake while children are awake. At the time of the visit there were 9 children present with 2 staff members. Licensee, Leslie Ruballos arrived about 20 minutes after LPAs arrival. LPA discussed Incidental Medical Services (IMS) with Licensee. Per Licensee, there are no children in care that require IMS at this time. During LPAs inspection there was an uncleared adult present in the home. Per licensee, a clearance for the adult was received; however, licensee could show proof of clearance. Licensee asked adult to leave until clearance is received.

This is a two-story home with 3-bedrooms, 3-bathrooms, a kitchen, living room, family room, dining area, backyard, and garage. There is a spa on the premises. Children have access to the living room, which is converted for childcare, the restroom located directly across from the stairs and the backyard. Off-limit areas of the home are the entire upstairs, the garage, the family room, kitchen, and the backyard area where a spa is located. LPA observed a safety gate at the bottom of the stairs to make the upstairs inaccessible to children. LPA observed a safety gate at two entrances to the kitchen to make the kitchen and the family room inaccessible to children. LPA observed safety knobs on the garage door to make the area inaccessible to children. LPA observed cleaning supplies and bug spray under the sink in the children’s bathroom. LPA observed assistant move cleaning supplies and bug spray to the garage. LPA observed hazardous materials in the backyard. LPA observed a shed in the backyard made inaccessible with a padlock. Per licensee, the materials were placed in the area yesterday and have been scheduled for trash pickup. The facility is near the end of their construction and RO was notified of construction on 8.1.23. LPA did not observe pets at the facility.

LPA observed a spa in the inaccessible backyard area. Per licensee, children are escorted to the play area.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: RUBALLOS FAMILY CHILD CARE
FACILITY NUMBER: 367700142
VISIT DATE: 06/19/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed latches on two sides of the spa cover. LPA observed cover can be lifted enough to see water in spa. Per licensee, latches will be placed on the other two sides of the spa to make it inaccessible. LPA observed hard spa cover that can hold the weight of an adult.

The home was inspected inside for comfort, cleanliness, telephone service, heating, and ventilation. Medications are stored in licensee’s bedroom upstairs inaccessible to children. The kitchen knives are stored in the inaccessible kitchen. Cleaning compounds are stored in the garage and under the kitchen sink inaccessible to children.

The First Aid kit is located in the childcare room inaccessible to children. Per licensee, there are no weapons or firearms in the home. LPA did not observe any weapons or firearms. Smoke detectors and carbon monoxide detectors are in operable condition. The Fire Extinguisher was serviced June 2024 and is green, fully charged, and meets the standards of the State Fire Marshal. The licensee’s Pediatric CPR/First Aid expires on 5.27.26. LPA observed that assistant also has valid Pediatric CPR/First Aid. The licensee has the required immunizations against pertussis (TDAP) and measles (MMR) and Influenza. The licensee completed the required Mandated Reporter training on 4.3.22. LPA observed that licensee is scheduled for virtual mandated reporter training on 7.11.24. Per licensee, she and staff will complete mandated reporter training by Friday, June 21, 2024, and submit proof to LPA via email by COB. Preventative Health and Safety Training was completed on 5.25.22. LPA provided PIN 23-11-CCP to licensee. Per licensee, once front door has been changed to appropriate single-action handle she will submit proof via photo to LPAs email.

The required posted documents were posted and located at the entrance accessible to parents: Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC9148).

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 were reviewed; The licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is 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; Regulation prohibits the smoking of any kind during the operation of the day care.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
Page: 2 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: RUBALLOS FAMILY CHILD CARE
FACILITY NUMBER: 367700142
VISIT DATE: 06/19/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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-andresources/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.

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.

The licensee was 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. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, licensees, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensee must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family childcare 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 "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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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: RUBALLOS FAMILY CHILD CARE
FACILITY NUMBER: 367700142
VISIT DATE: 06/19/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 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.

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/.

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.

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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

LPA confirmed that there are no Registered Sex Offenders living in the facility and completed the RSO profile in FAS during the file review.

This inspection visit was conducted in person. The report was read, and a copy was provided to the licensee, Leslie Ruballos. Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 06/19/2024 03:29 PM - It Cannot Be Edited


Created By: Kristina Diaz On 06/19/2024 at 02:40 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: RUBALLOS FAMILY CHILD CARE
FACILITY NUMBER: 367700142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 6 persons which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2024
Plan of Correction
1
2
3
4
Per licensee, background clearance will be obtained for uncleared adult prior to return to the facility and licensee will ensure all adults living or working in the home will have background clearance prior to being present in the facility.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Kristina Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 06/19/2024 03:29 PM - It Cannot Be Edited


Created By: Kristina Diaz On 06/19/2024 at 02:40 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: RUBALLOS FAMILY CHILD CARE
FACILITY NUMBER: 367700142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 2 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2024
Plan of Correction
1
2
3
4
Per licensee, training will be completed and proof of completion will be emailed to LPA by COB on POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Kristina Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024


LIC809 (FAS) - (06/04)
Page: 6 of 6