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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700367
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:45:28 PM

Document Has Been Signed on 10/23/2025 04:45 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
367700367
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/23/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Licensee Alicia Rodriguez TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On October 23, 2025 at 12:55pm, Licensing Program Analyst (LPA) Zirbes met with Licensee Alicia Rodriguez. The purpose of the inspection was to conduct a Annual/Random inspection and a capacity increase inspection at the licensed facility. The home was granted a fire clearance on October 14, 2025. LPA disclosed the purpose of the inspection to the Licensee. When LPA arrived to the facility, the Licensee was providing supervision to four children (one infant and three preschool age children). Current days and hours of operation are 7 days a week, for less than 23 hours a day pre family. Currently living in the home is the Licensee, Adult 1 (A1) and two minor children.
Physical Plant: 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 inaccessible at the time of this inspection via slide locks. On limits: Living room, open living space, bathroom 4 and backyard,
The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. According to Licensee and LPA observations, all cleaning products are stored in kitchen and laundry cabinets equipped with child safety locks and the off limits areas of the home. Sharp knives were stored in a kitchen cabinet equipped with magnetic child safety locks. According to the Licensee household medications were stored in the off limits bedroom. Safe and age appropriate toys, play equipment and materials were present. Smoke detector and carbon monoxide detector were tested. An audible beep was heard when the items were tested therefore, the carbon monoxide and smoke detector were in working order at the time of this inspection. Per Licensee no one smokes in the home.
Report continued on page two
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2025
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700367
VISIT DATE: 10/23/2025
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Report continued from page one
Physical Plant Continued: Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. Per Licensee, there are zero firearms or weapons stored in the home. The home has two fireplaces, which were inaccessible via mesh screens. The home has central heating and air conditioning. The exit doors were equipped with a single action handles.
Bathroom: Toilet, sink, faucet, were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.
Outdoor: The on limit outdoor space is accessible via a door in the living room. The backyard is completely fenced. LPA observed trikes, and child size table and chairs and an outdoor BBQ area. The home has an in-ground pool. The in ground pool is surrounded by a wrought iron fence with a secured mesh screening attached to the top which make the fence at least 5'. The fence is mounted on cement and grass. The 7 foot section of fence mounted on the grass had vertical clearance of four inches from the ground to the bottom of the enclosure. The distance exceeded the required 2 inch clearance, a technical advisory notice was issued. The bars of the fence are no more than 4” apart.  There are two gates that access the pool which swing away from the pool and are equipped with a self-closing, self-latching mechanism. The wrought iron gate on the side of the home was not equipped with a key lockable device, therefore a technical violation was issued. There are no items around the perimeter of the fence that would allow the fence to be climbable.  LPA observed a life ring with a diameter of at least 17 inches with a United States Coast Guard approval label, and a rescue pole with a body hook that is at least 12 feet long. LPA observed a pool alarm placed in the pool. The pool alarm was tested and found to be turned on, and in working condition. LPA heard the alarm make an audible sound. At the time of this inspection, the Licensee was able to provide documentation that the alarm was compliant with ASTM International Standard F2208. In addition, per record review, the Licensee was performing a daily inspection of the pool. The licensee understands and agrees that the life ring and rescue pole will be accessible at all times.

Per Licensee, the family has zero pets.



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NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700367
VISIT DATE: 10/23/2025
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Facility Records: Per Disaster drill log drills were completed in January 2025 and May 2025, therefore the drills are being conducted every six months as required. The Fire Extinguisher was serviced in August 2025.

File Review: LPA reviewed seven child files which included two infants. All child files were accurate and contained all required information. LPA reviewed the Licensees files and one household member file. All files were current and contained all required information. The Licensees mandated reporter training expires on 9.11.2027. Per LPA record review the Licensee has American Heart Association Pediatric First Aid/CPR with a renew date of 9.2027.

Because the licensee rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the Licensee confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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-andresources/
safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/..

Report continued on page four
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700367
VISIT DATE: 10/23/2025
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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 Alicia Rodriguez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
As a result of this inspection, two technical advisory notice were issued.

Approval of the capacity increase is pending completion of the technical advisory and final approval from the Licensing Program Manager.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Alicia Rodriguez.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC809 (FAS) - (06/04)
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