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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403530
Report Date: 01/21/2022
Date Signed: 01/21/2022 02:56:34 PM

Document Has Been Signed on 01/21/2022 02:56 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:CAZUN FAMILY DAY CAREFACILITY NUMBER:
197403530
ADMINISTRATOR:MARIA CAZUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 802-1854
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
01/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Maria CazunTIME COMPLETED:
03:13 PM
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Licensing Program Analyst (LPAs) King-Lewis and Liana Stepanyan conducted a required 1 year Inspection with licensee who guided analyst on a tour of the license day-care. The day care take place in the following area of the home: living room, family room, bedroom #1, hallway bathroom, front and rear yard. Licensee states the day care hours of operation is 6:00 AM to 6:00PM Monday thru Friday. Currently living in the home is licensee licensee's spouse, and minor daughter.

Physical Plant:

There are no body of water on the premises. Licensee stated there are no firearms or other dangerous weapons. Storage areas for poisons, are kept in the garage inaccessible to children. Medication are stored in the top kitchen cabinet secured with a kitty locked. Detergents, cleaning compounds and other items which could pose a danger to children are inaccessible to children stored in the off limit garage. LPA observed a couch in front of fireplace, inaccessible to children. Fire extinguishers, smoke detectors, and carbon monoxide appear to be operable. LPA observed the home to be orderly, central air and heating available. There is a land line telephone and a cell phone available for the license day care. LPA did observe a crib and play yard for infants use. Licensee stated she is currently caring for one infant. LPA observed all proper documentation to meet infant safe sleep regulation.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2022
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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Document Has Been Signed on 01/21/2022 02:56 PM - It Cannot Be Edited


Created By: Lady King On 01/21/2022 at 02:20 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: CAZUN FAMILY DAY CARE
FACILITY NUMBER: 197403530

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPAs observed the licensee did not comply with the section cited above due to air conditioner exhaust is not secured to the ceiling which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2022
Plan of Correction
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Licensee stated the air conditioner exhaust will be repaired within 24 hours and she will email LPA proof of correction.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Lady King
LICENSING EVALUATOR SIGNATURE:
DATE: 01/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2022


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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: CAZUN FAMILY DAY CARE
FACILITY NUMBER: 197403530
VISIT DATE: 01/21/2022
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LPA discussed safe sleep regulation, making licensee aware no infant shall be swaddle and car seat shall not be used for sleeping, to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the child status. Licensee was informed all infants shall have an individual infant Sleeping Plan (LIC 9227). Licensee should refer to regulation 102425(J) for documentation requirement. LPA reviewed requirement with licensee during this inspection visit. LPA informed of 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 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 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 at: http://www.ada.gov/childqanda.htm

Care and Supervision

Licensee is aware she must be present in the home and shall ensure that children in care are supervised at all times. Licensee states she provides transportation. LPA informed licensee to make sure the transportation vehicle is proper insured to transport day care children. Licensee is aware the capacity stated on the facility license shall be the maximum number of children being cared for at one time.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022
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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: CAZUN FAMILY DAY CARE
FACILITY NUMBER: 197403530
VISIT DATE: 01/21/2022
NARRATIVE
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Facility Records Review

LPAs observed facility current roster of children, current fire and disaster drill, and current mandated reporter training certificate. Licensee is aware that all employees or volunteer at the day-care shall be immunized against pertussis and measles and maybe immunized against influenza.

Facility Administration

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Licensee aware to immediately remove individual and prevent individual for returning to the home or having contact with children in care upon notice from the department to remove an individual and all individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in the license home. Licensee is aware any authorized employee of the Department may enter and inspect any place providing personal care and services at any time with or without advance notice. Licensee is aware other personnel shall complete training on preventive health practices including CPR and first aid per regulation 102416 (c). Licensee and licensee’s assistant CPR and first aid card expire 10-2022.

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022
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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: CAZUN FAMILY DAY CARE
FACILITY NUMBER: 197403530
VISIT DATE: 01/21/2022
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During this inspection facility was observed not to be in compliance with Title 22. Please see LIC 809D for deficiency.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the licensee a copy of this report and a notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022
LIC809 (FAS) - (06/04)
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