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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700230
Report Date: 12/04/2025
Date Signed: 12/04/2025 02:42:24 PM

Document Has Been Signed on 12/04/2025 02:42 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
367700230
ADMINISTRATOR/
DIRECTOR:		MARIA RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 200-1369
CITY:MORONGO VALLEYSTATE: CAZIP CODE:
92256
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
12/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Licensee, Maria Rodriguez TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On December 4, 2025, at 09:45a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Annual/Random inspection and met with Licensee Maria Rodriguez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Per Licensee, three adults (Licensee, adult 1, adult 2) and one minor child currently reside in the home at this time. All adults are associated and have eligible clearances. Upon arrival LPA observed seven children (three infants and four preschool age children) in care with the Licensee and adult 2 providing supervision. During the inspection one additional preschool child and staff 3 arrived to the home. Current days and hours of operation are Monday thru Friday, 6:30am to 10:30pm.

This is a single story home with three bedrooms, two bathrooms, living room, kitchen/dining area, and outdoor space. A in-ground pool and spa are present in the backyard. On limit areas consist of living room, one bathroom (located off the living room), bedroom 4 and a portion of the backyard. Please note prior to this inspection bedroom 4 was an off limit area. LPA toured bedroom 4 during this inspection and approved the space as an on limit area). The Licensee provided LPA with an updated facility sketch. Current off limit areas include Bedrooms 1, 2, 3, the primary bathroom and the kitchen, and a portion of the yard. Children use the kitchen as a passage way to the outdoor space.

Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. Per Licensee household medications are stored in a cabinet above the refrigerator. Report continued on page two

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 12/04/2025 02:42 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 12/04/2025 at 01:05 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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700230

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when child 1 was sleep in a pack n play equipped with a tent cover that was attached to the side of the crib, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2025
Plan of Correction
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Per Licensee, the pack n play tents will not be utilized. All tents were removed during this inspection.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Kendal Zirbes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2025


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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700230
VISIT DATE: 12/04/2025
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Report continued from page one
Physical Plant Continued: Cleaning products were stored under the kitchen sink in a cabinet equipped with a child safety latch and on a high inaccessible shelf in a closet in the kitchen. In addition the kitchen was inaccessible via a child safety gate. Sharp knives were stored in a container on a high kitchen shelf. Safe and age appropriate toys, play equipment and materials were present inside the home. Per Licensee no one smokes in the home. Licensee reported guns or weapons are stored in the home. Based on information received from the provider the guns/weapons are stored according to the regulations. 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. There is a wood burning stove in the living room. The wood burning stove was inaccessible via two couches placed on either side and a barrier placed in front of the wood burning stove. Per Licensee the home has central heating and air conditioning therefore the wood burning stove is only used when the child care is closed. During the inspection the smoke detector and carbon monoxide detector were tested. An audible sound was heard when the items were tested therefore the smoke detector and carbon monoxide detector were found to be operable at this time. Bathroom (located off the living room). Toilet, sink, shower/tub were clean and operable. Cleaning products were stored in a cabinet equipped with a child safety latch.
During the walk through of the home, LPA observed four pack 'n plays in the licensed spaces. Three of the pack n plays were equipped with Dofilachy Black crib tents. One of the pack n plays was equipped with a L Runnzer Pack N Play Tent. LPA observed one infant (child 1) sleeping in a pack n play equipped with a Dofilachy Black crib tent. This tent has a panel that stretches over the top of the pack in play. The crib tent was secured with ties to each corner of the pack n play. LPA observed the panel stretching over the top half of the canopy cover was open, allowing the licensee to observe the infant while sleeping. Licensee stated she has been utilizing the crib tents as a safety measure to protect the sleeping infants in case the older children throw items into the air. Licensee stated she has been utilizing the tents for one month. During this inspection all tent covers were removed. A type B citation was issued for regulation 102425(b)(3) as the tent was attached with ties to each corner of the of the pack n play. LPA and Licensee reviewed the safe sleep regulations.
Outdoor: A portion of the backyard is utilized for child care activities. Access to the outdoor space is gained by walking through the off limit kitchen. The outdoor activity space consists of a wrought iron gated area. LPA observed push and pull toys, basketball hoop, slides and additional toys. Report continued page three
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700230
VISIT DATE: 12/04/2025
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Report continued from page two
Outdoor space continued: LPA observed a in-ground pool and a above ground covered spa in the backyard. The bodies of water were surrounded by a 5 foot wrought iron fence that was mounted into cement. There was one gate that provided access to the bodies of water. The gate was observed to be self closing and self latching with a key lockable device placed no lower than 60 inches. During the inspection, LPA measured the vertical clearance from the ground to the bottom of the wrought iron fence. The vertical clearance was 2 inches. LPA observed a life ring with a minimum exterior diameter of 17 inches hanging in the pool area. Per LPA observation the life ring was labeled as approved by the United States Coast Guard. LPA observed a 12 foot rescue pool with body hook attachment. A pool alarm was in the pool at the time of this inspection. The pool alarm was tested and made an audible noise. The Licensee was able to provide documentation that the pool alarm was compliant with ASTM International Standard F2208. LPA observed the daily inspection of the pool was being completed as required. Per Licensee there are six dogs, 30 chickens, one guinea pig and one bird. Per Licensee the animals do not interact with the child care children.
Review of records to be maintained: Per recorded documentation the Licensee is conducting emergency drills every two months. Therefore the drills were being completed every six months as required. The fire extinguisher was serviced in 2025. LPA reviewed six child files, the licensees file, three staff members files. Based on LPA record review, Two of two staff members (Staff 1 and Staff 2) files were missing documentation of the measles immunization. Licensee stated S1 and S2 have received the immunization's, the paperwork has just been misplaced. A technical advisory notice was issued. Furthermore based on LPA review, all six child files contained the PM 286, however the Licensee was not updating the PM 286 with the information from the immunization records. A technical advisory notice was issued.

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.

Report continued on page four
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700230
VISIT DATE: 12/04/2025
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Report continued from page three
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-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any 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.
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/.
Licensee 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.
During the exit interview, the Licensee Maria Rodriguez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
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.
Based on LPA observations and record review, one type B citation and three technical advisory notices were issued today.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Maria Rodriguez.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC809 (FAS) - (06/04)
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