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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700287
Report Date: 05/10/2023
Date Signed: 05/10/2023 02:47:21 PM

Document Has Been Signed on 05/10/2023 02:47 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:DAVILA FAMILY CHILD CAREFACILITY NUMBER:
367700287
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH: Isabel Davila TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Maddox met with applicant, Isabel Davila today for the purpose of conducting a Pre-Licensing/Capacity Increase 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 that is at least 5 ft high, the gate opens away from the pool and there is a spring closure in place and a latch that's at least 4 ft from the bottom. LPA tested the gate to ensure it the spring latch allows the gate to close automatically when opened. All adults living/residing in the home are fingerprint cleared and associated (Licensee, 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 located in the rear of the home, Licensee also utilizes the backyard (fenced in area only), 1 bathroom, and dining 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 room), 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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 05/10/2023
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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). There were 6 children present (no children present were under 12 months).

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 outdoor play shall be supervised by the Licensee at all times while children are present. There is a storage room located in the backyard that was locked during this inspection. There is a trampoline on the children's play yard (about 3 ft high from the ground) that is off limits to day care children -(the opening has two latches in place to make it inaccessible, the ladder that leads up to the trampoline must be removed while day care children are present). There are 2 covered patios in the back yard; 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. There are 2 dogs that are kept in a dog run

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 nap on cots, Windows are free from cracks, bugs and debris. There are no hanging window blinds /cords accessible to children.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 05/10/2023
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LPA informed Licensee 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.

There were no violations noted as a result of this unannounced inspection, capacity increase will be granted. Exit interview conducted, copy of this report was read and provided to Licensee, Isabel Davila.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: DAVILA FAMILY CHILD CARE
FACILITY NUMBER: 367700287
VISIT DATE: 05/10/2023
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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 Licensee:

Requirements to conduct fire and disaster drills once every six months and record it (last drill was conducted in February 2023); Role and responsibilities of being a mandated reporter; 100% supervision is required at all times to children in care; Licensee is aware it is her responsibility to know the regulations as well as anyone who assists in providing care; Community Care Licensing (CCL)must have the facility’s current phone number at all times; if the phone number is changed, CCL must be notified.

Licensee was reminded 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 (LIC 624) shall be submitted to the department within seven days following the occurrence. The email address to forward the written report is UnusualIncidentReport.dss.ca.gov.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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