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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700412
Report Date: 03/27/2024
Date Signed: 03/27/2024 03:23:42 PM

Document Has Been Signed on 03/27/2024 03:23 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:CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
367700412
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Melissa CervantesTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye conducted an announced visit with Applicant Melissa Cervantes who guided the analyst on a tour of the home for a Location Change and Capacity Change Inspection. This is a two-story home with 4 bedrooms, 3 bathrooms, a kitchen, dining area, living room,family room, laundry room,Backyard and garage. There is no pool/or body of water on the premises. Family members residing in the home include two adults (The applicant ,Spouse) and six children. Days/hours of operation will be Monday through Friday from 6:00 AM to 6:00 PM.

Physical Plant: The home is clean and orderly,there is no fireplace in the home, LPA observed age-appropriate toys and play equipment, a working smoke detector and carbon monoxide detector, and a 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 living room,family room, bathroom #1 and the backyard is utilized for the family childcare, off-limit areas include all of the home’s upstairs bedrooms #2,#3,#4, downstairs bedroom #1, bathroom #2,#3,kitchen,garage and upstairs laundry room. The upstairs stair case is made inaccessible by a child gate.,bedroom #1 inaccessible with child safety lock, garage inaccessible with child safety lock.There is a working telephone (cell phone), poisons, and cleaning items inaccessible (laundry room) to children (off-limit),

Kitchen/bathroom: The following are inaccessible: Sharp items (above the kitchen counter in a cabinet), medications (above the kitchen counter in a cabinet),the cabinet inaccessible with child safety lock and chemicals (laundry room) are inaccessible. The toilets and faucets are clean and operable.

Outdoor: LPA observed the backyard of the home. The backyard is safe for children, LPA Observed Air condition units inaccessible with a tared plastic cover. The applicant shall supervise the outdoor play.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 03/27/2024
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The area of the backyard used for childcare is fenced (wood/brick wall) and gated .LPA observed age-appropriate toys and play equipment, This play area is clear and clean of debris. LPA did not observe any items that could be hazardous to children in care.

Advisory/Other: First Aid kit readily available. CPR/First Aid expires 08/3/2024, Mandated Reporter expired 6/9/2024. The electrical outlets are covered. LPA observed 2 mat for children/infants to nap. Per the licensee, the children will nap in the living room. The applicant is reminded to supervise children at all times.

Pets: Per the licensee, there are no pets in the home. LPA did not observe any pets during the pre-licensing inspection.

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.html

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

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 03/27/2024
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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: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 03/27/2024
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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 & The 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.

The fire clearance granted by fire department on 03/21/2024. The applicant is ready for licensure; the applicant has met Title 22 regulations for a Large Family Child Care Home License with a childcare capacity of 14 children which will be granted today 03/27/2024.



An exit interview was conducted, and a copy of this report was given to the Applicant Meissa Cervantes. All Licensing reports are recommended to be kept for a minimum of three years.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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