367700396-1-3-2024-12-CC-KZIS-CZ5UZY-20240103150220

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700396
Report Date: 01/03/2024
Date Signed: 01/03/2024 03:02:33 PM

Document Has Been Signed on 01/03/2024 03:02 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:	AGUIRRE FAMILY CHILD CARE		FACILITY NUMBER:	367700396
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/03/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Applicant Tamara Aguirre		TIME COMPLETED:	03:15 PM

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On January 3, 2024, at 09:20 a.m Licensing Program Analyst (LPA) Kendal Zirbes, conducted a Pre-Licensing inspection with applicant Tamara Aguirre 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 the applicant, and four children (15, 12, 11, 3). LPA toured the home indoor and out to ensure it meets FCCH requirements. Applicant is requesting to provide care for children, 3 months to 12 years of age and is requesting the days and hours of operation will be Monday thru Sunday 24 hours a day.
The home is described as follows:

This is a single story home with four bedrooms, two bathrooms, kitchen, dining area, living room, garage with front yard and back yard. Off-limits areas: Bedroom 1, bathroom 1 (located in bedroom 1) , garage, and a portion of the backyard. The off limit areas were inaccessible via child safety door knob covers, and locked doors. On limits: Bedrooms (2,3,4), Bathroom 2 (located in hallway), kitchen, living room, dining room, and a portion of the yard.

Indoor:

On limits:

Living Room/dinning room: LPA observed a couch, television, shelving units, table with four chairs, child size portable table, art easel and a fireplace. The shelving units and television were secured to walls. A wooden barrier wrapped around the fireplace which made the fire place inaccessible to the children in care. Kitchen: LPA observed refrigerator, stove, sink. All appliances were in working condition and the area was clean and sanitary. Sharp knives and cleaning supplies were located in cabinets equipped with a child safety locks.
Bedroom 2: Currently unoccupied. The room was set up as a activity space for the child care children. LPA observed books and dramatic play equipment. Continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: AGUIRRE FAMILY CHILD CARE	FACILITY NUMBER: 367700396
	VISIT DATE: 01/03/2024

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Report continued from page one

Bedroom 3: Currently unoccupied. The room was set up as a napping/activity area for infants. LPA observed three cribs, and toys for the children.
Bedroom 4: Currently unoccupied. The room was set up as a classroom space, with child size tables and chairs, art supplies, and educational posters on the walls.
Bathroom 2 (located in hallway): LPA observed a toilet, sink, shower/tub. The area was clean and sanitary at the time of the inspection. Chemicals/cleaning supplies were located in the cabinet under the sink. The cabinet was equipped with a child safety lock therefore the items were inaccessible.
Outdoor space: The on limit outdoor space is accessible via the door in the kitchen. The outdoor space is completely enclosed with a wooden fence. LPA observed cement walk way/riding area for small bikes, and a large grass area. LPA observed dramatic houses, and Little Tikes play structures with swings. Play structures were placed on the grass and were secured to the ground. The outdoor play space is "L-shaped" therefore LPA and Applicant discussed active supervision.

Off-limit areas
Bedroom 1: Occupied by Applicant, and children. The room was furnished with a queen size bed, twin size bed, and personal furnishings. The room was inaccessible via child safety door knob cover.
Bathroom 1 (located within bedroom 1): LPA observed toilet, sink, shower and personal care items. The area was clean and sanitary at the time of the inspection.
Garage: Accessible via the backyard. The area is used for household storage, and tools. The area was inaccessible via a locked door.
Outdoor space (backyard): accessible via a locked glass slider in the dining room. The area consists of a covered patio and a in-ground pool. The pool was surrounded by a wooden fence and a metal side gate placed on cement and dirt. Sections of the wooden pool fence measured 58.5 inches in height and another section was 40.5 inches in height, therefore the fence did not meet the 5 ft (60 inch) requirement. One of the pool gates was a 4 foot metal chain link fence, that also did meet the height requirement. In addition, the two pool gates swung towards the pool and were not self closing self latching. Approximately three vertical wooden bars were more than 4" apart. There were no items around the perimeter of the fence that would allow the fence to be climbable. LPA advised the Applicant that the fence does not meet the Title 22 requirements at the time of this inspection. Report continued on page three.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: AGUIRRE FAMILY CHILD CARE	FACILITY NUMBER: 367700396
	VISIT DATE: 01/03/2024

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Report continued from page two
Napping equipment: LPA observed three cots and three mini portable cribs. Applicant is willing to purchase play yards and other sleeping material as necessary to meet the needs of the children.
Electrical outlets: All electrical outlets were inaccessible in the home.
Weapons or Firearms: Per the applicant there are zero weapons or firearms stored in the home.
Cleaning compounds: Were observed in kitchen, bathroom 1, bathroom 2. All cleaning products were inaccessible at the time of this inspection via child safety locks or doors equipped with child safety door knob covers.
Smoke detector and a carbon monoxide detector: A smoke detector and carbon monoxide detector were located in the hallway of the home.
Fire extinguisher: The home had a 3A10BC fire extinguisher which was obtained in August 2023. LPA discussed the State Fire Marshall standards of replacing or servicing the fire extinguisher each year.
Pets: Zero pets are in the home.
Household Medications: Stored in a locked closet located near the front door. The closet door was equipped with a child safety door knob cover.
Knives/Sharp Items: Knives were stored in a kitchen cabinet equipped with a child safety lock.
Documentation:
Applicant has current CPR, First Aid Training with the expiration dates of 05/01/25. Applicant completed the Health and Safety Training with the nutrition and lead components on 5/7/2023 and mandated reporter training on 3/15/23. Applicant has obtained a fingerprint clearance and submitted the required immunization's.
Transportation: Per Applicant transportation may be provided depending on the needs of the enrolled families.
Meals: Per Applicant meals and snacks will be provided by the applicant.

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 Report continued on page four

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: AGUIRRE FAMILY CHILD CARE	FACILITY NUMBER: 367700396
	VISIT DATE: 01/03/2024

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Report continued from page three

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 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.

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.

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 platform.

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.

As a result of this inspection, the following is required:

1. The in-ground pool must meet Title 22 regulations.

The above corrections will be competed within 30 days.

Exit interview conducted and report was reviewed with the applicant Tamara Aguirre.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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