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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700386
Report Date: 01/18/2024
Date Signed: 01/18/2024 12:16:36 PM

Document Has Been Signed on 01/18/2024 12:16 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:PABON FAMILY CHILD CAREFACILITY NUMBER:
367700386
ADMINISTRATOR:EVANGELINA PABONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 662-0850
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Evangelina PabonTIME COMPLETED:
12:37 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye conducted an announced visit with Applicant Evangelina Pabon who guided the analyst on a tour of the home for a Change of location Pre-licensing Inspection for a large family child care home. This is a two story home with 3 bedrooms, 3 bathrooms, day-care room, a kitchen, dining area, living room, laundry room, backyard and garage. There is no pool/or body of water on the premises. Family members residing in the home include three adults (The applicant, spouse and adult daughter) . Days/hours of operation will be Monday through Friday from 6:00 AM to 8:00 PM.

Physical Plant: The home is clean and orderly, there is a fireplace in the family room which is inaccessible to children with a glass barrier locked. LPA observed age-appropriate toys and play equipment, a working smoke detector and carbon monoxide detector, and fully charged 2A10BC Fire Extinguisher. Per the applicant, no one smokes in the home. There is a designated area for the ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current, applicant states day-care room and bathroom #1 will be utilized for family child care. off-limit areas include all of the home’s upstairs bedroom #1-#3, living room downstairs, kitchen/dining, bathroom #2,#3, backyard, garage and laundry room. All off-limits area will be made inaccessible by a child gate. There is a working telephone (cell phone), poisons, and cleaning items inaccessible (The following are inaccessible: Sharp items (above the kitchen counter in a cabinet), medications will store in off-limits area kitchen cabinet), and chemicals (laundry room) are inaccessible. The toilets and faucets are clean and operable.

Outdoor: LPA observed the backyard of the home. off-limits per applicant children will not currently have access to backyard, LIC 855 (Declaration Provided) LPA observed one storage with boxes). The storage is made inaccessible with a lock, LPA Observed Air condition units, BBQ grill covered, patio furniture, the backyard is fenced (wood wall) and gated. (Off-limits)

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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: PABON FAMILY CHILD CARE
FACILITY NUMBER: 367700386
VISIT DATE: 01/18/2024
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Advisory/Other: First Aid kit readily available. CPR/First Aid expires 12/3/2024. The electrical outlets are covered. LPA observed mats, for children/infants to nap. Per the licensee, the children will nap in the day-care room. The applicant is reminded to supervise children at all times.

Pets: LPA Observed three dogs inaccessible in a cage upstairs, per applicant all the shot records are up to date. per Applicant the dog will remain in the cage during day-care hours

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 the 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.

Documents Provided and or Discussed: The following were discussed regarding Title 22 requirements: Safe Sleep and Large Family Child Care Home Ratios

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.

The 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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: PABON FAMILY CHILD CARE
FACILITY NUMBER: 367700386
VISIT DATE: 01/18/2024
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Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; 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 reminded that 100% supervision is required at all times to children in care; Applicant made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day-care.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant 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 before the close of the next working day following the occurrence during the operation of the family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family child care home and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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: PABON FAMILY CHILD CARE
FACILITY NUMBER: 367700386
VISIT DATE: 01/18/2024
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The applicant advised that the Notice of Site Visit must be posted at the facility entrance for 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 & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from the 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.

Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed change, 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 childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when the local building inspector requires an inspection as a result of the alteration, addition, or construction

Corrections needed before the application can be submitted for approval by 01/25/2024



1. The hallway, stair, living room and kitchen area will be made inaccessible by a child gate.

An exit interview was conducted, and a copy of this report was given to Applicant Evangelina Pabon.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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