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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700284
Report Date: 12/04/2025
Date Signed: 12/04/2025 02:36:19 PM

Document Has Been Signed on 12/04/2025 02:36 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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
367700284
ADMINISTRATOR/
DIRECTOR:		KINA & KYNUNULA GREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 514-8836
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Kina Green, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 12/4/2025, Licensing Program Analyst (LPA) Ana Rodriguez conducted an unannounced annual inspection at Green Family Child Care. Upon arrival, LPA was greeted by the licensee, Kina Green, who provided a facility tour. The home is occupied by 4 adults (the licensee, her husband, and 2 adult children). LPA observed 0 children in care. The licensee stated that the facility operates 23 hours Monday through Sunday. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children currently require IMS.
The home is set up as follows:
This is a one–story house with 3 bedrooms, 2 bathrooms, living room, family room, dining room, kitchen, and a garage. No pool, spa, or body of water is on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, and ventilation. It has central heating and air conditioning, and all windows have screens free of cracks, bugs, and debris.
Main Area: The living room and dining room are for childcare. Children can access the family room, kitchen and backyard.
Living Room: LPA observed age-appropriate toys and furniture in the designated childcare areas. There is child-size furniture and several plastic storage bins containing games and toys for the children. The facility also has books available. Mats with educational and learning activities are on the floor and were noted to be in good condition. An adult-size couch is present, and a TV is used to play educational videos for the children.
Children's Bathroom (#1): The children’s bathroom is located upon entry to the right near the living room. LPA observed that the toilet and faucets are clean and operable. The medication cabinet is free of medications or personal items. The bathroom was found to be clear of any hazardous items.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2025
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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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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 367700284
VISIT DATE: 12/04/2025
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Kitchen: The kitchen was inspected for safety, and it was noted that hazardous items are kept out of children's reach with child safety latches. Sharp utensils, poisons, and medications are not accessible to children. Sharp knives are stored in plastic container in the upper cabinet to the left of the sink.
Backyard: The backyard was inspected; The children use the backyard for outside play. The backyard is gated all around. The outdoor play area was observed to be free of hazards and loose and sharp parts. LPA observed a grass and concrete area for active play. A decorative water fountain was observed to the far right of the backyard, it contained some water and dubris. Per Licensee, fountain will be drained and filled with rocks to make it inaccessible to day care children.
Overnight care: According to the Licensee, overnight care will be provided. Licensee was reminded that the provider shall remain awake whenever children are awake. The door to the room where the provider is sleeping as well as the door to the room where the children in care are sleeping shall remain open. If the sleeping arrangements are not situated in such a way that the provider can be assured of hearing a child in care wake up, a digital video and audio monitoring device shall be used. Regulation, Title 22 Division 12 Chapter 3 Article 06. Continuing Requirements 102426 Overnight Care.
Off-limit: The front yard, bedrooms 1-3, bathroom 2, and garage(key lock door knob) are inaccessible to the daycare children.

Additional Information: According to the licensee, there were no bodies of water in the home. LPA did not observe any bodies of water. An AC/Heating unit is located on the left side of the backyard and is inaccessible to children, with plastic mesh blocking access. All unused electrical outlets are plugged and inaccessible to children. The licensee provide breakfast, lunch, dinner and snacks. A required fire extinguisher (2A10BC) was observed on kitchen counter near the sink. It is reading in the green zone, inaccessible to children, and meets standards established by the State Fire Marshal. The fireplace in the family room, it is screened and inaccessible to children. No window blind cords present. If a child shows signs of illness, they will be separated from other children and stay in the family room. Detergents and cleaning compounds are stored in the garage, out of children’s reach, and medications are kept in an off-limits bedroom. Children will nap under adult supervision in designated areas like the living room. LPA observed 14 mats. No pets present in the home. The home has a working landline and cell phone. Smoke detector and carbon monoxide devices located in the hall near bathroom 1 were tested at 1:41pm and found to be operable. The licensee does provide transportation for the children. They possess a valid California driver's license, vehicle insurance, and vehicle registration. Per the licensee, there are no weapons or firearms at the facility. LPA did not observe any weapons or firearms.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 367700284
VISIT DATE: 12/04/2025
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Child Files: LPA reviewed 3 children's records. The files contain all necessary licensing documents with parents’ signatures.
No Infants Enrolled: The licensee confirmed that no infants aged 0-24 months are enrolled.
Immunization Records: The licensees have up-to-date immunizations for MMR and DTaP, and both have submitted written statements declining the influenza vaccine.
CPR/First Aid: LPA verified that the licensees hold current Pediatric CPR and First Aid certifications, which expire on 11/10/26.
Mandated Reporter Training: The licensees completed the online mandated reporter training at www.mandatedreporterca.com, which expires on 10/27/27.
Fire/Disaster Drill: The licensee conducts fire and disaster drills every six months, with the last drill documented on 8/26/25.
Required Postings: LPA observed that the licensee does have the Facility License, Emergency Disaster Plan, Earthquake Preparedness, and Parents' Rights Poster displayed as required.
The following information was discussed with the licensee:
-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.
-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/.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 367700284
VISIT DATE: 12/04/2025
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-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 Kina Green, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies are being cited at this time.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Kina Green
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Ana Rodriguez
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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