367700391-5-19-2026-12-CC-CALI-DU8V7C-20260519161056

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700391
Report Date: 05/19/2026
Date Signed: 05/19/2026 04:11:28 PM

Document Has Been Signed on 05/19/2026 04:11 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:	REQUENA FAMILY CHILD CARE		FACILITY NUMBER:	367700391
ADMINISTRATOR/ DIRECTOR:	BRENDA REQUENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 680-8490
CITY:	OAK HILLS	STATE: CA	ZIP CODE:	92344
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	05/19/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:35 PM
MET WITH:	Brenda Requena, Licensee		TIME VISIT/ INSPECTION COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 19, 2026, Licensing Program Analyst (LPA) Crystal Ali conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was granted entry by Licensee. Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observe 10 children (1 infant), Licensee and one assistant. This is a large capacity licensed home. Licensee's facility child roster is current. There are no IMS children. All adults in the facility have an approved background check clearance through Guardian. Licensee states there are 16 children enrolled. The operational childcare hours are Monday through Friday for 5:00am to 9:00pm. Staffing Ratio and Capacity: This is a one-story family home. There is a dining room, family room, kitchen, garage, laundry room, pantry, office, three bathrooms, three bedrooms, preschool room, baby room, and backyard. The off-limits areas are the two bedrooms with attached bathrooms, dining room, office, laundry room, pantry, garage, and kitchen. There are no bodies of water on premises. Per the Licensee, there is no smoking and no weapons on the premises.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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: REQUENA FAMILY CHILD CARE	FACILITY NUMBER: 367700391
	VISIT DATE: 05/19/2026

NARRATIVE

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Physical Plant: 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. The daycare areas (on-limits) are one bathroom, baby room, preschool room, family room, and backyard. Licensee does provide food for the children (morning snack, lunch, and afternoon snack). Licensee is not part of food program. The children can bring packed lunches. Licensee states she provides food to all children except for infants. Parents provide formula for infants and diapers. Licensee provides wipes for infants. There are no window cords in the daycare area. There are age-appropriate toys and equipment on the premises. LPA observed safety guard screwed into fireplace doors in the family room. LPA observed in family room cubbies for all children to put their belongings. Licensee utilizes cell phone for daycare business.

Napping: Children are provided napping when needed. Licensee provides napping materials, cots, play yards, and blankets. LPA observed naptime. Napping materials are cleaned every Friday.

Transportation: The licensee does not provide transportation

Kitchen: Kitchen is off-limits, LPA observed safety gate in place. Knives and medication were observed in locked pantry, inaccessible to children. Licensee reports that there are no children on medication. Cleaning supplies and chemicals are kept under the sink and in laundry room (locked door), inaccessible to children. Licensee states there are no children with allergies at this time. LPA observed water purifier machine in kitchen.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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: REQUENA FAMILY CHILD CARE	FACILITY NUMBER: 367700391
	VISIT DATE: 05/19/2026

NARRATIVE

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Fire Extinguisher: The required fire extinguisher (2A10BC) is reading in green and in located on the wall next to the bathroom. Licensee states she will be getting fire extinguishers serviced 5/20/26 at 9:00am. Smoke and carbon monoxide detectors were found to be in compliance per Fire Marshall Standards. Licensee states the fire marshal come last in 2024. Fire and Disaster drills are conducted at least every six-months, last drill documented 1/6/26 (fire drill) and 2/16/26 (earthquake drill). The First Aid kits (2) included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept on the wall up high in preschool room and in the backyard.

Pets: There are two dogs on the premises, and they do not interact with the children. Licensee states the dogs are current on their vaccinations.

Bathroom: The daycare bathroom is located on the left of hallway. Bathroom is clean and in good repair. LPA observed a potty-training toilet.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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: REQUENA FAMILY CHILD CARE	FACILITY NUMBER: 367700391
	VISIT DATE: 05/19/2026

NARRATIVE

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Outdoor Space Activity: The outdoor area is the backyard. The back yard is free of broken toys/furniture & equipment, and other sharp items. The backyard has AstroTurf grass and concrete patio with shade.

Records/Documentation: LPA reviewed with facility representative the LIC 126, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Staff records are not complete. Assistant #4 does not have documentation of TB results. Children’s records (3) are complete. Licensee had all the required posted documents: Facility License (LIC 203A, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148).

Criminal Record Clearance - Family Child Care Homes
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.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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: REQUENA FAMILY CHILD CARE	FACILITY NUMBER: 367700391
	VISIT DATE: 05/19/2026

NARRATIVE

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Safe Sleep - Family Child Care Homes
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, 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: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org – Family Child Care Homes
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Megan’s Law - Family Child Care Homes
During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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: REQUENA FAMILY CHILD CARE	FACILITY NUMBER: 367700391
	VISIT DATE: 05/19/2026

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Deficiencies cited: (see LIC809D) One Type B in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Brenda Requena.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/19/2026 04:11 PM - It Cannot Be Edited

Created By: Crystal Ali On 05/19/2026 at 03:49 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: REQUENA FAMILY CHILD CARE	FACILITY NUMBER: 367700391
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102369(b)(9)

Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in not having documentation of Tuberculosis clearence for Assistant #4 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/22/2026
	Plan of Correction
1 2 3 4	Licensee states documentation of TB results will be provided to LPA by email or text message.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Francisco Pedroza
NAME OF LICENSING PROGRAM MANAGER:

	Crystal Ali
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC809 (FAS) - (06/04)

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