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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700412
Report Date: 08/28/2025
Date Signed: 08/28/2025 02:59:39 PM

Document Has Been Signed on 08/28/2025 02:59 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:CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
367700412
ADMINISTRATOR/
DIRECTOR:		MELISSA CERVANTESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 385-9337
CITY:HESPERIASTATE: CAZIP CODE:
92344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
08/28/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:53 PM
MET WITH:Melissa Cervantes, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 8/28/25, 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. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observe two daycare children, licensee’s three minor child under age of ten that count towards her capacity, 1 child (licensee's child over the age of ten), and assistant (spouse). This is a large capacity licensed home. Licensee's facility child roster is current and maintained up to date. The operational childcare hours are Monday through Saturday for 5:00am to 5:00pm. They do not offer overnight care. Licensee says there is no weapons in the home, no smoking, and no bodies of water.
Staffing Ration and Capacity: This is a two-story family home. There is a living room, dining room, family room, kitchen, garage, four bedrooms, three bathrooms, laundry room, and backyard. The off-limits areas are the upstairs (bedroom #2-4, bathrooms #2-3, and laundry room), bedroom #1 (downstairs), and, right side of backyard, the garage.
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.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2025
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: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 08/28/2025
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Licensee does provide food for the children (morning snack, lunch, and afternoon snack, and dinner). Licensee says she is in the Angels food program. The children can bring packed food if they choose too. Those lunchboxes that don’t have ice packs are placed in the refrigerator for the children in care. Licensee says children don’t bring food, they provide food for the children. There are no window cords in the daycare area. There are age-appropriate toys and equipment on the premises. There is no fireplace.

Napping: Children are provided napping when needed in living room. Licensee provides napping materials, mats and blankets stored in closet in bedroom #1. Licensee states they clean mats after eat use.


Pets: The home has one small dog that stays in the home. Licensee states the dog does not interact with the children.
Transportation: The licensee does provide transportation. Pick-ups and drop offs for school age children. LPA verified that driver’s license and car insurance are valid for the Licensee.
Kitchen: Knives and sharp kitchen tools were observed in pantry on top shelf with safety knob on pantry, inaccessible to children. Medication is kept in kitchen above refrigerator, inaccessible to children. Licensee states there are no child on medication and no food allergies. Chemicals located under the sink in the kitchen with safety latches on cabinets.
Fire Extinguisher: The required fire extinguisher (2A10BC) is reading in green and in located on the wall next to pantry. Smoke and carbon monoxide detectors were found to be in compliance per Fire Marshall Standards. Fire Marshall came last year when the daycare became a large capacity and relocation. Fire and Disaster drills are conducted at least every six-months, last drills were recorded in 6/4/25 at 12:00pm for Earthquake/Disaster and Fire Drill.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 08/28/2025
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The daycare areas (on-limits) are downstairs only; bathroom, living room, dining room, family room, kitchen, and backyard. The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, and cleansing pads/solution was observed to be complete and inaccessible to children kept in safety latched cabinet in kitchen across from refrigerator.
Bathroom: The daycare bathroom is located near the front door. It has 1 sink, 1 toilet, and a shower/tub. The bathroom is in good repair.
Outdoor Space Activity: The outdoor area is the backyard. The backyard is free of broken toys/furniture & equipment, and other sharp items. LPA observed large table, play doom, plane play equipment, and soccer net. LPA observed weeds bushed that need to be removed or trimmed down, airplane play equipment needs to be anchored to ground, and side gate needs latch repaired. The right side of the home is off limits to the children by gate.
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. Licensee and assistant files are in compliance. Children’s records (3) files are in compliance. 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
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 08/28/2025
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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.
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 childcare 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: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 367700412
VISIT DATE: 08/28/2025
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No deficiencies cited 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, Melissa Cervantes.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC809 (FAS) - (06/04)
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