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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700287
Report Date: 07/21/2022
Date Signed: 07/21/2022 04:34:57 PM

Document Has Been Signed on 07/21/2022 04:34 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:DAVILA FAMILY CHILD CAREFACILITY NUMBER:
367700287
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
07/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Applicant, Isabel DavilaTIME COMPLETED:
04:54 PM
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Licensing Program Analyst (LPA) Maddox met with applicant, Isabel Davila today for the purpose of conducting a Pre-Licensing inspection. This is a single home with 4 bedroom, 2 bathrooms kitchen/dining, living room, family room, backyard and garage. There is an in ground pool in the backyard, the pool was completely surrounded by wrought iron fencing. The opening to the pool has a spring closures and a latch that's at least 4 ft from the bottom. All adults living/residing in the home are fingerprint cleared and associated (Applicant, her husband) and 3 minor children. Days/hours of operation will be Monday through Friday from 7am to 6pm. The family room is designated as the main child care area.

Physical Plant: Home is clean and orderly, fireplace is inaccessible, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC), no one smokes in the home (sign posted on parent board). There is a designated area for ill child(ren) as necessary (the living), there are no weapons/firearms in the home, facility sketch complete, current and matches the home, off-limit areas are identified as all bedrooms, pool area; storage room; and garage (the bedrooms will be kept locked while day care children are present). There is a working telephone on the premises; all cleaning solutions and hazardous items are inaccessible via child latches and kept in high cabinets. Medicines are inaccessible to children (located in an upper cabinet in hallway).

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 07/21/2022
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Kitchen: The kitchen is toured, Sharp utensils are kept up high; Cabinets have child proof latches

Bathroom: Toilets and faucets are clean and operable and toilet paper and paper towels are available. Bathtub and shower are free of hazards. There's no medicine cabinet, cabinet underneath the sink has a child latch in place.

Outdoor: The yard is safe for children (inaccessible – lawn mower, gardening tools, poisonous plants, thorn trees, cactus, pets). The outdoor play shall be supervised by the Applicant. There is a storage room located in the backyard that will be kept locked while children are present. There is a trampoline that will be off limits to day care children -(the opening has two latches to make it inaccessible). There are 2 covered patios; built in BBQ pit; 2 stand alone BBQ pits (propane tanks kept in the storage room); and a Wooden swing set (the swing set is heavy enough that it will not tip when occupied); This play area is clear and clean of debris.

Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 8/24/23; Mandated Reporter expires 12/12/23; The electrical outlets are covered. Children will nap on cots, There are 3 dogs (kept in dog run - pets have current vaccinations); Windows are free from cracks, bugs and debris. There are no hanging window blinds /cords accessible to children.

Applicant 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 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 07/21/2022
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The following were observed/discussed and or provided: Seat Belt Safety, Safe Sleep poster observed – PIN 19-02-CCP, forms required for childrens file (LIC311D), Notification of Parents' Rights (PUB394), Roster (LIC9040), Staffing and Ratio (capacity limitations handout provided), Lead Flyer Requirement, liability insurance (LIC182) must have signed form on file if no liability insurance.

LPA discussed the safe sleep regulations with Applicant 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 applicant 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.

Prior to making alterations or additions to a family child care home or grounds, the Applicant shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 07/21/2022
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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 - discussed during this inspection.

The following was discussed with the Applicant:

Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Applicant was reminded that 100% supervision is required at all times to children in care; Applicant is aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Community Care Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified;

Applicant was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours. In addition, a written report shall be submitted to the department within seven days following the occurrence. Applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 07/21/2022
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Applicant advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & Applicant must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Exit interview conducted, copy of this report was read and provided to Applicant, Isabel Davila. Applicant needs to provide proof of Health & Safety training and LPA will verify fingerprint clearances for all adults before licensure.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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