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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700249
Report Date: 02/21/2023
Date Signed: 02/21/2023 06:37:42 PM

Document Has Been Signed on 02/21/2023 06:37 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:KOHLER FAMILY CHILD CAREFACILITY NUMBER:
367700249
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:14 PM
MET WITH:Laura KohlerTIME COMPLETED:
06:30 PM
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On February 21, 2023, Licensing Program Analyst (LPA) Kuliema Calloway, conducted an unannounced Required 1-Year inspection at the Kohler Family Child Care. Upon arrival, the LPA met with the licensee, Laura Kohler who guided the LPA on a tour of the facility. Family members residing in the home include three (3) adults (licensee, spouse, licensee's adult children). All adults living in the home have been background cleared. Per the licensee, the hours of operation are Monday through Sunday 5:00 a.m. to 4:00 a.m. for 23 hours care. Licensee's assistant (husband)was present during this inspection, and six (6) childcare children were observed.

The Home is set up as follows:
This is a two story 5-Bedroom, 3-Bathroom home with a kitchen, living room, formal dining room, laundry room, and garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.
· Main Area: Main care is provided in Living Room (downstairs) and Dining Room. Children use the bathroom located down the hall next to the kitchen. Children have access to the kitchen and backyard. LPA observed age-appropriate toys and furniture for the children. There are games and books on the premises of this facility. LPA observed a infant inside a bouncy seat and another play toy with wheels that can be used as a walker. Licensee removed the items from the child care area.
· Children's Bathroom (#1): Children use the bathroom down the hallway next to the kitchen. The children walk through the kitchen to get to the bathroom. The Bathroom was toured and inspected sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
VISIT DATE: 02/21/2023
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·Kitchen: During the visit, the kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children. LPA observed the kitchen cabinets and drawers did not have safety latches and items inside the lower cabinets were plastic dishes, not harmful and made accessible to the children. In the kitchen, all sharp utensils were stored inside the pantry which has a key- locked door. Per Licensee, the door remains locked during child care hours, making the sharp objects inaccessible to the children. Per licensee, there is a gate used across the stove and other cabinets making the other cabinets inaccessible to children. LPA did not observe the gate up or hazards during the time of the visit. LPA advised Licensee to keep gate up while children are in care.
· There is a grass and concrete area for active play. There are no swings or slides. There is a trampoline that is not for the day care children. At the time of the visit, LPA observed it was not locked, making the are accessible to the children. Licensee was reminded, it must always remain locked while kids are in care. LPA observed age appropriate toys, one large swing and climbing apparatus that are for three years old and up. LPA reminded Licensee, children need to be supervised at all times during play.
Ø Off-limit: It include the home's entire upstairs (Stairs have a gate): (4 bedrooms, 2 bathroom), downstairs, laundry room has a key locked door and one bedroom that is locked during care. The garage has a key lock (entry through the laundry room). The laundry and garage are inaccessible to children. LPA observed a door lock or key lock on the door.
Ø Others:
· AC/Heating Unit was observed. AC/Heating Unit is located in the back yard and is not covered. It is accessible to children while playing in the yard.
· Bodies of water: Per the licensee, there are no bodies of water in the home. LPA did not observe any bodies of water.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (2A10BC) that is reading in Green and located in the kitchen, high on the wall and inaccessible to children. It meets standards established by the State Fire Marshall.
· Fireplace: The fireplace was observed in the main care area. It is covered with a large white board for drawing and it is mounted to the fireplace, making the fireplace inaccessible to the children.
· Hanging window blind cords: The cords are inaccessible to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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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: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
VISIT DATE: 02/21/2023
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·Incidental Medical Services (IMS): 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.
· Isolation area (Illness): Per the licensee, if the child shows signs of illness, he/she will be separated from other children and stay in the dining room on a cot underneath the counter area.
· Medications and cleaning solutions: Detergents/cleaning compounds are in the kitchen pantry cabinet that are locked and off limits to the children in care.
· Napping: Children will nap in the designated nap areas with adult supervision. LPA observed four mats in the closet.
· Overnight Care: Pre-licensee, she does provide overnight care. Care is 23 hours.
· Pets: Two dogs. They have current vaccinations. The dogs do not interact with the day care children.
· Phone service: There is a working landline and licensee has a cell phone.
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested and are operable.
· Stairs (For two story access): There is a safety gate or barricaded to make the stairs inaccessible to the children.
· The First Aid kit is located in the key-locked pantry inaccessible to children. The First Aid Kit was observed complete with supplies and a first aid manual.
· Transportation: The licensee provides transportation for children. The licensee and licensee's assistant have a valid California driver's license, valid vehicle insurance, and vehicle registration.
· Weapons or Firearms: Per Licensee, there are no Firearms at the facility at this time. LPA does not observe any firearms.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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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: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
VISIT DATE: 02/21/2023
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Documentation:
· Child files: LPA observed six (6) children's files contained all required licensing documents.
· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date October 2023. 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Criminal Record: Pre Guardian, all adults who live in this facility obtain a criminal record clearance.
· Facility fees: Per Licensing Information System, facility annual fees were current.
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 9/10/2022.
· Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP, and Influenza. Negative TB skin test was observed for licensee and assistant.
· Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed 2 infants have LIC 9227 and the Sleeping log is on a clipboard in the sleeping area.
· The licensee has posted as required the Facility License, Emergency Disaster plan, Earthquake Preparedness, and Parent's Rights Poster
· Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 11/27/2021 and husband, assistant on 1/25/2023.
· Staff Personnel File: LPA observed two (2) staff information. LPA observed LIC 508, 9052, IZ, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. The file contained all required licensing documents.
· Staffing Ratio and Capacity: This is a small/large family childcare facility. LPA observed six (6) children (one infant, three preschoolers, and two toddlers) during the inspection. Licensee had a assistant.
Ø The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The licensee is reminded that 100% supervision is required for children at all times.
ü Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü All food is properly labeled if brought from child’s home; and all food is checked periodically for expiration dates.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
VISIT DATE: 02/21/2023
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üLicensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was 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.
ü Licensee 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 LIC624B
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
Criminal Record Statement: Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the 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.

ü Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 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.


ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
ü Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
ü Type A citation: LPA Calloway informed licensee that this report dated February 21, 2023 document(s) two (2) Type A citations were cited). Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
VISIT DATE: 02/21/2023
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Also, LPA Calloway informed the licensee to provide a copy of this licensing report dated February 21, 2023 that documents 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 this 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.
ü The 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). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
ü Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

Two (2) Type A Deficiencies were cited: (See LIC 809D). The following Type A deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.



Exit interview conducted and the report was reviewed with the licensee, Laura Kohler.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/21/2023 06:37 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 02/21/2023 at 06:11 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: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(10)
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: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

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 one out of six chilldren (C6) were observed by LPA inside a bouncy seat which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2023
Plan of Correction
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All bouncy seats, and baby walkers shall be removed and not used in the child care area by 2/22/2023.
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

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 one out of six children (C1) were observed by LPA inside the play pen with toys and blankets while child was inside which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2023
Plan of Correction
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Licensee was infomed there cannot be toys or blankets inside the play pens with the infant children and must be removed by 2/22/2023.
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: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023


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