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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700318
Report Date: 12/08/2022
Date Signed: 12/12/2022 08:33:39 AM

Document Has Been Signed on 12/12/2022 08:33 AM - 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:SASIS FAMILY CHILD CAREFACILITY NUMBER:
367700318
ADMINISTRATOR:CELINNA SASISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 782-5008
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Celinna Sasis TIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA), Maddox met with with applicant, Celinna Sasis for the purpose of conducting an announced Pre-Licensing/Relocation inspection. Present today was applicant and Sister N Law. This is a 2 story with 5 bedrooms, 4 bathrooms. Family members residing in the home include 2 adults (applicant and her spouse). All adults in the home have fingerprint clearances and exams for T.B., LPA verified applicant has required immunization's. Main area of care is conducted in the casita which is attached to the home but has a separate entrance, bathroom, and kitchenette. Applicant hours of operation will be from 8:30am - 11:30 am. LPA explained to applicant to notify the Department if her hours change.

The kitchenette and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children (in the main area and above the sink and child latches). All unused electrical outlets are plugged and play equipment and toys are available. Applicant is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility.

The backyard is surrounded by fencing, there is a fire pit that was covered and separate BBQ grill that was also covered. There are no bodies of water on the premises. There is a small dog in the home (immunization's verified).
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SASIS FAMILY CHILD CARE
FACILITY NUMBER: 367700318
VISIT DATE: 12/08/2022
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Applicant has current CPR and First Aid training (exp 1/22/24). Health and Safety Training verified (dated 12/8/19). Per Applicant, there are weapons in the home stored according to Regulations. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devises were are present and in operable condition.
Applicant is reminded to maintain a current roster and document Emergency Disaster drills no less than twice a year.

· Applicant can access forms on line at www.ccld.ca.gov . LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility.

The Applicant is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

Applicant states she will not care for Infants, the only infant in the home will be Applicants biological child.

******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 o 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 - Not at this time



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

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SASIS FAMILY CHILD CARE
FACILITY NUMBER: 367700318
VISIT DATE: 12/08/2022
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Applicant has current Mandated Reporter Training (exp 12/24).

**Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation. **Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty. In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report documenting the Type A citation and sign form LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to. Staff is aware of required forms for children's files and forms that shall be posted after licensure.

Fire clearance has been granted for a large capacity, home is ready for licensure

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8am-5pm. Exit Interview conducted a copy of this report is discussed and left at the facility.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
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