367700367-10-16-2023-12-CC-KZIS-CWNTAN-20231016143348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700367
Report Date: 10/16/2023
Date Signed: 10/16/2023 02:34:01 PM

Document Has Been Signed on 10/16/2023 02:34 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	367700367
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/16/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Applicant Alicia Rodriguez		TIME COMPLETED:	02:45 PM

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On October 16, 2023, at 9:15 a.m Licensing Program Analyst (LPA) Kendal Zirbes, conducted a Pre-Licensing inspection with applicant Applicant Alicia Rodriguez to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The applicant is requesting to open a Small family child care home (FCCH) with a capacity of eight children. Currently living in the home are five adults (Applicant, Adult 1, Adult 2, Adult 3, Adult 4) and two minor children (ages 3 and 4). LPA toured the home indoor and out to ensure it meets FCCH requirements. Applicant is requesting to provide care for children, 6 weeks to 13 years of age and is requesting the days and hours of operation will be Monday through Sunday, 5:00 a.m. to 6:30 p.m..
The home is described as follows:

This is a single story home with three bedrooms, four bathrooms, kitchen, living room, open living space, laundry area, attached garage, and front and back yard, with an in-ground pool and spa. Off-limits areas: All bedrooms, (1,2,3), bathroom 1, bathroom 2, bathroom 3, and the attached garage. The off limits areas: bedrooms and bathrooms were not inaccessible at the time of this inspection. LPA advised the Applicant that all off limit areas had to be made inaccessible during operating hours and prior to being granted a FCCH license. On limits: Living room, open living space, bathroom 4 and backyard,

Indoor:

On limits:

Living room: LPA observed cots, one crib, cubbies and a diaper changing area. Per conversation with applicant this area will be utilized for napping. A fire place was present. The barrier on the fire place in the living room was not secured to the wall. LPA advised the Applicant that prior to licensure the barrier must be secured to the wall.

Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700367
	VISIT DATE: 10/16/2023

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Report continued from page
Open living space: LPA observed two child size tables and chairs, a dramatic play area, library area, educational posters on the walls and specific a space for infants/toddlers. The area also had a fire place with a barrier that was secured to the wall, therefore the fireplace was inaccessible
Kitchen: LPA observed refrigerator, stove, sink. The area was clean and sanitary. Sharp knives are stored in a high cabinet equipped with magnetic locks. Chemicals were stored in the cabinet under the kitchen sink. The cabinet was equipped with a child safety lock.
Laundry area: LPA observed washer, dryer and cabinets. Chemicals were stored in cabinets equipped with child safety locks.
Bathroom 4: Located near the kitchen/laundry room. LPA observed toilet and sink. Paper towels and soap were available. The area was clean and sanitary. LPA reminded the Applicant that shampoo and personal care products must be inaccessible to the children in care.
Backyard: The backyard is completely fenced. LPA observed one small climbing structures placed on grass, multiple balls, trikes, and an outdoor BBQ area. LPA and Applicant discussed the fall zone for the climbing structure. LPA advise the applicant to ensure the climbing structure is surrounded by grass or a cushioning material. LPA and Applicant discussed active outdoor supervision.
The pool is surrounded by a wrought iron fence that is mounted on concrete and grass. The gate opens away from the pool and is equipped with a self-closing, self-latching mechanism on top of the gate. During the inspection, LPA measured the wrought iron fence and found sections of the fence were 4ft 7 inches. In addition, opening between railings measured 5 inches, and the bottom of the fence was more than 2" from the grass. Furthermore, windows from the house provided direct access to the pool. LPA advised the applicant that the pool does not meet the regulations. LPA and applicant discussed pool requirements.
Off-limit area
Bedroom 1/Bathroom 1: Occupied by Applicant, A4, C1 and C2. The room is furnished with two beds and personal items. The bathroom had a shower, toilet sink. The room was accessible at the time of this inspection.
Bedroom 2: Currently occupied A2 and A3. The room is furnished with two beds and personal items. The room was accessible at the time of the inspection. Continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700367
	VISIT DATE: 10/16/2023

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Report continued from page two
Bedroom 3: Currently occupied by A3. The room is furnished with a bed and personal items. The room was accessible at the time of this inspection.
Bathroom 2: Shower, toilet, sink. The bathroom was accessible at the time of the inspection.
Bathroom 3: Toilet, sink. The bathroom was accessible at the time of the inspection.
Garage: Used for the storage and household items. The garage was inaccessible at the time of this inspection.
Napping equipment: LPA observed cots and a crib.
Electrical outlets: All outlets in the on limit areas were equipped with safety covers.
Weapons or Firearms: One firearm was present in the home. The firearm was stored according to Title 22 regulations at the time of this inspection.
Cleaning compounds: Cleaning compounds were stored in the off limits bathrooms, bedrooms, in the cabinet under the kitchen sink and in a cabinet in the laundry room. The cabinet under the kitchen sink and in the laundry room were equipped with child safety locks.
Smoke detector and a carbon monoxide detector: Tested and operable.
Fire extinguisher (2A10BC). Located in the kitchen. The fire extinguisher was purchased in September 2023. LPA and Applicant discussed the State Fire Marshall Standards during the inspection.
Pet: There are zero pets on the property.
Household Medications: Stored in the off limits bedrooms/bathrooms.
Knives/Sharp Items: Stored in kitchen cabinet equipped with a child safety lock.
Documentation:
Applicant has current CPR, First Aid Training with the expiration dates of 9/2025. Applicant completed the Prevented Health and Safety Training with the nutrition and lead components on 9/2/2023 and mandated reporter training on 10/1/23. Applicant and other adults have fingerprint clearances and required immunization's on file. Per Applicant transportation will be provided. Meals and snacks will be provided by the Applicant.

Report continued on page four

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700367
	VISIT DATE: 10/16/2023

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Report continued from page three

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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage: atttps://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.

Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

LPA and Licensee discussed the children's personal rights

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Report continued on page five

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700367
	VISIT DATE: 10/16/2023

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Report continued from page four

As a result of this inspection, the following corrections are required prior to being issued a license:

1. Make the off limit areas inaccessible

2. Ensure the in-ground pool and spa meet the requirements.

3. Ensure the fireplace in the living room is inaccessible

4. Ensure all cleaning compounds are inaccessible.

Applicant has requested 30 days to make the required corrections.

An exit interview was conducted, and a copy of this report and appeal rights were discussed with the Applicant Alicia Rodriguez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC809 (FAS) - (06/04)

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