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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700230
Report Date: 03/07/2022
Date Signed: 03/07/2022 03:21:09 PM

Document Has Been Signed on 03/07/2022 03:21 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
367700230
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Maria RodriguezTIME COMPLETED:
03:35 PM
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On March 7, 2022 at 11:50AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Applicant, Maria Rodriguez, who guided analyst on a tour of the facility for a Pre-licensing inspection. This is a single story 4 bedroom, 2 bathroom home with kitchen/dining, and living room. There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (applicant, applicant spouse) and five children. Hours of operation are Monday Through Friday, 6:00AM until 6:00PM. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in living room (at entrance). Children use the bathroom adjacent to living room. Off limits areas include Bedroom #1 through #4, bathroom #2, and kitchen. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kitchen storage closet), medicines (off-limits kitchen) and hazardous items (sharp knives in top kitchen cabinet in tool box) that can pose a danger to children. Applicant reminded to conduct fire/earthquake drills every 6 months and document. A Roster was provided to Applicant to complete and maintain.

The backyard is completely fenced. There is a swing/slide anchored to the ground. There are two dogs that stay in dog run, 10 chickens that stay in chicken coop, 5 parakeets and 2 cockatiels that stay in bird cages in living room. The facility has a tetherball and other age appropriate outdoor toys for children to use. Facility is on 2 acre plot of land. Applicant provided declaration stating she will provide supervision to children while they play outside.

Per Applicant, there are weapons or firearms on the premises, which LPA observed stored per Title 22 Regulations. There are age appropriate toys. Age appropriate napping equipment (mats). The required fire extinguisher (3A40BC), smoke detector, and carbon monoxide detector are in operable condition. There is no fireplace on the premises. Facility has wood-burning stove with door kept closed. Home has central AC and heat. CPR/First Aid expire 07/17/2023. Preventive Health and Safety completed 07/25/2021. The First Aid kit was observed and is complete with no touch thermometer.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700230
VISIT DATE: 03/07/2022
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LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted.

Applicant 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 LIC624. Pamphlet Information regarding SIDS, Seat Belt Safety, and Notification of Parent's Rights poster (Palmdale Regional Child Care Office) were provided. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents.

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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 applicant 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 applicant 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.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700230
VISIT DATE: 03/07/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

COVID-19 technical assistance was provided during inspection.

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8:00AM-5:00PM. LPA provided consultation during the inspection.
Before licensure the following must be completed:
1. Child safety gate securely installed at kitchen entrance.

Once corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn.

Exit interview conducted and report was reviewed with the applicant Maria Rodriguez.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
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