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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700240
Report Date: 10/28/2022
Date Signed: 10/28/2022 01:34:04 PM

Document Has Been Signed on 10/28/2022 01:34 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:MEDINA FAMILY CHILD CAREFACILITY NUMBER:
367700240
ADMINISTRATOR:SONIA MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 887-7576
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 414CENSUS: 5DATE:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Sonia Medina, LicenseeTIME COMPLETED:
01:43 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
Licensing Program Analyst (LPA) Donna Maddox met with Sonia Medina Licensee, who guided analyst on a tour of the home to conduct an annual random inspection. The home is a single-story family home with 4 bedrooms and 2.5 bathrooms. All adults in the home, license, husband, and 2 adult sons (son's do not live in the home) have fingerprint clearances and exams for T.B. (Licensee states her son's no longer appear on her roster, LPA informed Licensee to complete form LIC9182 Criminal Record Clearance Transfer form to add them back to onto her roster). The main areas of care are conducted in the following areas: The living room; 1 bathroom, kitchen/dining, office/day care area, and back yard.

During the time of this inspection LPA observed 4 children in care. Per LIS, facility annual fees are current. Licensee is operating within ratio/capacity during the time of inspection. Licensee has and assistant was also present during this inspection. This facility operates from 6:00 am to 6:00 pm Monday though Friday. Licensee has current CPR and First Aid training (exp 1/2024) and Mandated Reporter training (7/22/23).

Children nap in the front bedroom on mats, the mats were, observed to be age appropriate and in good and sanitary condition.


SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 367700240
VISIT DATE: 10/28/2022
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 kitchen is located next to the living room. The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children. Sharp objects and knives are inaccessible to children. Lower cabinets in the kitchen were observed to be free and clear of hazardous items.

The attached garage was observed to be locked during the time of this inspection. LPA observed that the garage was locked via a key bolt lock. The garage is used for storage only, and the garage is off limits to children.

Children utilize a bathroom located in the hallway, the bathroom was toured and LPA found no hazardous items accessible (there was no medicine cabinet or cabinet underneath the sink). The bathroom was observed to have a functioning toilet, and sink.

Children have access to the backyard area. Children exit to the backyard by utilizing a door in the kitchen. There is an in-ground swimming pool located in the backyard surrounded by wrought iron fencing. LPA verified the fencing is at least 5ft tall, there are 2 entry gates into the pool area, 1 gate will not be used, the main entry gate opens away from the pool and has a spring closure in place. The entire backyard is completely surrounded by brick fencing. LPA observed several toys in the back yard area in which children have access to. The toys were observed to be in good condition. All toys were observed to be in good condition.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 367700240
VISIT DATE: 10/28/2022
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
Licensee was reminded there shall be no smoking, no infant walkers, johnny jumpers, exersaucers and any other item that fall into that category. Also discussed were earthquake, fire & disaster drills shall be documented at least once every six months. Posting requirements were discussed such as the posting of the Parent’s Rights poster in a visible location for the children’s authorized representatives along with a copy of the License.

LPA reviewed children records. The records were complete. Licensee and her assistant has immunization's for pertussis, measles, and influenza. Immunization's were observed; copies were obtained for the licensee's file

All electrical outlets were properly covered. The home is clean, orderly, comfortable and well ventilated. The smoke detector was working during the inspection and in operational condition. A fire extinguisher 2A10BC was observed to be on the premises that meets fire marshal standards. The home has a working telephone service available. Licensee maintains a disaster/fire drill log as required.

This home was clean, orderly and comfortable for children in care. This facility has a first aid kit on premises. This facility has a current roster. Licensee has completed the mandated reporter training.

Per licensee there are no weapons or firearms on the premise. Areas off limit include: all bedrooms and 1.5 bathrooms, the laundry room, and the garage.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 367700240
VISIT DATE: 10/28/2022
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
Licensee is not providing any medical services to children. 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


LPA printed out the following during this inspection:
New Safe Sleep Regulations along with form LIC 9227
Information Regarding Lead Poisoning

There were no violations noted as a result of this inspection

Exit interview was conducted and a copy of this report was read and discussed with licensee. Licensee was given a copy of appeal rights during this inspection.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4