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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700231
Report Date: 09/26/2023
Date Signed: 09/26/2023 01:28:39 PM

Document Has Been Signed on 09/26/2023 01:28 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:SILVERA FAMILY CHILD CAREFACILITY NUMBER:
367700231
ADMINISTRATOR:VICTORIA SILVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 436-5806
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
09/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Laraya Davis, AssistantTIME COMPLETED:
01:30 PM
NARRATIVE
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On September 26, 2023, Licensing Program Analyst (LPA) Calloway met with Licensee’s Assistant, who granted access. Licensee was not home when LPA arrived. LPA and Licensee toured the home inside and outside for an Annual Random inspection. Family members residing in the home include 2 adults (licensee and licensee’s spouse), and three minor children. All adults living in the home are criminally background cleared. The home is licensed for fourteen (14) children. There was one (1) assistant present during the inspection. LPA arrived and observed eleven (11) day care children: One napping toddler on their stomach. Two infants in active play in daycare area. There was one toddler (2yrs) and six preschoolers (3-5 yrs.) in active play outside one sleeping infant (3 months) sleeping in back bedroom and one (1) staff.
Physical Plant: This is a one story 4-bedroom, 2- bathroom home with kitchen, dining, family room, living room, laundry area, and garage. Childcare is provided in the Living room and family room (upon entry). Age-appropriate toys, furniture, and books. Napping (mats) equipment. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry area- gated), medicines in kitchen (magnetic lock). Kitchen hazardous items that can pose a danger to children (sharp knives) top upper cabinet (magnetic lock). Fire/earthquake drills (not current). Roster (not current).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231
VISIT DATE: 09/26/2023
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The required fire extinguisher (2A10BC) is full/green. Fire pull observed. Smoke detectors/carbon monoxide detectors (operable). Fireplace (screened- safety latch). LPA recommended a gate. Home has central AC and heat. Required postings were all present on the wall. Unused outlets (covered). No Landline phone only cell phone. Child Bathroom is in hallway (right) LPA observed the safety latch was not on the lower left cabinet and there were accessible cleaning supplies. The shower had shampoos, soaps, that were accessible to the children with a shower curtain.Off limit areas: include Bedrooms (#1, #2, #3, #4), Bathroom #2 laundry area (gated) garage (thru laundry room).
Outside: The backyard is completely fenced. One pet (dog) observed (vaccinated) interacts with day car children. Age-appropriate toys and play apparatus. No pool/spa or body of water on the premises. There is a small water table. LPA recommended removal. Artificial grass for play. AC unit (covered).
Other: Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any in the home. Required training (Mandated Reporter- expired) and CPR/First Aid (current). The First Aid kit (observed). LPA viewed staff and children’s files and conducted a staff interview with the Licensee. Transportation is provided (insurance verified).
The following was discussed with the Licensee:
Maintain Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, updated. Safe Sleep regulations were discussed and provided. The role and responsibilities of being a mandated reporter. Licensee reminded that 100% supervision is always required to all children in care. If food is brought in, it is properly labeled. Licensee will check food expiration dates periodically. Licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231
VISIT DATE: 09/26/2023
NARRATIVE
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Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). Type A citation: Type A citation(s) shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of the report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category inside the day care home. The licensee is advised visit www.shotsforschool.org for Immunization information.
--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640
--Family Child Care Providers (Disaster Planning information): https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Child Care Videos: https://ccld.childcarevideos.org
--Licensee advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231
VISIT DATE: 09/26/2023
NARRATIVE
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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 On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm for information and reporting Unusual Incident Reports on LIC 624B form. LPA provided consultation (Safe Sleep) during the inspection.

Per Title 22 Regulations, there are deficiencies cited during the inspection. See 809 D pages.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit, and Appeal Rights were provided to Victoria Silvera, Licensee at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/26/2023 01:28 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/26/2023 at 01:04 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: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

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 in LPA observed cleaning compounds, shampoos in bathroom unlocked and accessible to day care children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2023
Plan of Correction
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I will double check when my children leave to ensure the supplies are put away and I will provide a written declarations to Licensing by POC date of 9/27/23 stating this will be done.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observationand interview, the licensee did not comply with the section cited above in LPA observed assistant alone with eleven day care children and Licensee was not home which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2023
Plan of Correction
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I will take the older kids with me that will not go over capacity. I will provide a written declaration to Licensing to state that is what I will do by POC date of 9/27/23.
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:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 09/26/2023 01:28 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/26/2023 at 01:04 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: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in the fire and earthquake drills were not conducted in the last six months as required. Which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2023
Plan of Correction
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Licensee will provide proof of fire and earthquake drill to Licensing by POC date of 10/10/23.

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:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/26/2023 01:28 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/26/2023 at 01:04 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: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review the licensee did not comply with the section cited above four out of four infants do not have a infant sleeping log which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2023
Plan of Correction
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Licensee will provide proof of infant log for each individual infant to Licensing by POC date of 10/10/23.
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
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Based on observation, interview, record review, the licensee did not comply with the section cited above in having a current Mandated Reporter training on their staff files for Licensee. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2023
Plan of Correction
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Licensee will provide proof of Mandated Reporter training to Licensing by POC date of 10/3/23.
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:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 09/26/2023 01:28 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/26/2023 at 01:04 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: SILVERA FAMILY CHILD CARE
FACILITY NUMBER: 367700231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and record review, the licensee did not comply with the section cited above in C15 child did not have current immunization records inside their file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2023
Plan of Correction
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Licensee will provide proof of immunization records for C15 by POC date of 10/10/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


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