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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700229
Report Date: 12/02/2021
Date Signed: 12/02/2021 12:33:02 PM

Document Has Been Signed on 12/02/2021 12:33 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:CENDEJAS FAMILY CHILD CAREFACILITY NUMBER:
367700229
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/02/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Krystal CendejasTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Donna Maddox and Babatunde Ibitoye conducted an announced visit with Applicant KRYSTAL CENDEJAS who guided analyst on a tour of the home for a Pre licensing Inspection. This is a two-story home with 3 bedrooms, 3 bathrooms, kitchen, dining area, 1 living room, garage and laundry room. There is pool in the premises which is inaccessible with a gate. Family members residing in the home include two adult (Applicant and Boyfriend) and one child. Days/hours of operation will be Monday through Friday from 6:30 AM to 6:30 PM.

Physical Plant: Home is clean and orderly, there is a fireplace in the living room area inaccessible with glass door(with key per applicant the key will always be removed during operation) , per applicant she will purchase age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, and fully charged 2A10BC Fire Extinguisher. Per licensee no one smokes in the home. There is a designated area for ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current, off limit are include all the upstairs three bedrooms, garage, laundry room, and Pool area. There is a working telephone (cell phone),

Kitchen/bathroom: The following are inaccessible: Sharp items (above kitchen counter in a cabinet), medications in the off-limits area upstairs, chemicals poisons and cleaning items above the kitchen cabinet. Toilets and faucets are clean and operable.

Outdoor: LPA's observed the homes backyard. The backyard includes two sections. section of the backyard is where the children will play. Applicant will use the backyard for children to play The on limits backyard area includes area which children can play. LPA did not observe any items that could be hazardous to children in care. The off-limits area of the backyard includes the pool area which is inaccessible with a mesh fencing and the gate that open away from the pool. LPA'S observed a self-latching device in place.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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 4
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: CENDEJAS FAMILY CHILD CARE
FACILITY NUMBER: 367700229
VISIT DATE: 12/02/2021
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Advisory/Other: First Aid kit readily available. CPR/First Aid expire 06/12/2023. The electrical outlets are covered. . Per licensee the children will nap in the play area and living room. Applicant always reminded to supervise children at all time.

Pets: Per licensee there are no pets in the home. LPA did not observe any pets during the pre-licensing inspection.

LPA advised Applicant All adults living/residing in the home are fingerprint cleared and associated.

Documents Provided and or Discussed: The following were discussed regarding Title 22 requirements: Safe Sleep and Small Family Child Care Home Ratios

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

The following was discussed with the Applicant: 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; Applicant reminded that 100% supervision is required at all times to children in care; Applicant made aware that it is 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.

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

Applicant 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.

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 childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. 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.

Corrections needed before application can be submitted for approval:


1. Applicant will put furniture corner protector on the table
2. Replace mash fencing panel in the pool area
3 Fire pit cannot be used when day cay children are present
4 put the child proof knob on the stove
5. The applicant will send the picture of Mat for children to take nap before accepting children
6 The applicant will send picture of toys before she start accepting children

Exit interview conducted and a copy of this report was given to Applicant KRYSTAL CENDEJAS.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CENDEJAS FAMILY CHILD CARE
FACILITY NUMBER: 367700229
VISIT DATE: 12/02/2021
NARRATIVE
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Advisory/Other: First Aid kit readily available. CPR/First Aid expire 06/12/2023. The electrical outlets are covered. . Per licensee the children will nap in the play area and living room. Applicant always reminded to supervise children at all time.

Pets: Per licensee there are no pets in the home. LPA did not observe any pets during the pre-licensing inspection.

LPA advised Applicant All adults living/residing in the home are fingerprint cleared and associated.

Documents Provided and or Discussed: The following were discussed regarding Title 22 requirements: Safe Sleep and Small Family Child Care Home Ratios

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

The following was discussed with the Applicant: 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; Applicant reminded that 100% supervision is required at all times to children in care; Applicant made aware that it is 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.

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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: CENDEJAS FAMILY CHILD CARE
FACILITY NUMBER: 367700229
VISIT DATE: 12/02/2021
NARRATIVE
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Applicant 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.

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 childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. 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.

Corrections needed before application can be submitted for approval:


1. Applicant will put furniture corner protector on the table
2. Replace mash fencing panel in the pool area

The following are recommended before children are accepted:
1. Fire pit cannot be used when day cay children are present
2. put the child proof knob on the stove
3.. The applicant will send the picture of Mat for children to take nap before accepting children
4. The applicant will send picture of toys before she start accepting children

Exit interview conducted and a copy of this report was given to Applicant KRYSTAL CENDEJAS.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4