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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153907301
Report Date: 08/04/2023
Date Signed: 08/07/2023 08:39:42 AM

Document Has Been Signed on 08/07/2023 08:39 AM - 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:JAIMES, ADELA FAMILY CHILD CAREFACILITY NUMBER:
153907301
ADMINISTRATOR:JAIMES, ADELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 903-3194
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
08/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Adela JaimesTIME COMPLETED:
02:20 PM
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On 08/04/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Jaimes Child Care Home. Upon arrival, the LPA met with the Licensee, Adela Jaimes, who guided the LPA on a tour of the facility. Family members residing in the home include 4 adults (licensee, licensee’s spouse, Licensee’s mother and Licensee’s father). There are no minor children in the home. All adults living in the house have been background cleared. Per the Licensee, the hours of operation are Monday through Friday, 5:00AM to 5:00 PM for less than 24 hrs. Per licensee, no overnight care is provided. Upon arrival, LPA observed 14 children in care. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a one-story, 3-bedroom, 2-bathroom home with a kitchen, living room, dining area, day care room (Converted Garage with permits) and backyard. Upon arrival, LPA observed an additional conversion (Porch) that has not been reported to the department where children utilize for short activities. A type B violation was cited for this violation. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows are free of cracks, bugs, and debris. All electrical outlets are covered.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301
VISIT DATE: 08/04/2023
NARRATIVE
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Records: Children, infant and staff records were observed to be incomplete. A Type B Citation was issued for this deficiency. Licensee’s CPR/First Aid is maintained current, it expires on 04/08/2023. Mandated reporter is maintained current, it expires 05/16/2024. Per LIS annual fees are up to date. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 08/02/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Required documents and forms for children and staff. Safe Sleep PIN 20-24-CCP and LIC 9227 (Individual Sleeping Plan) and Sleep Logs. The Licensee was reminded that supervision is always required for children in care.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe. Applicant was advised that all LIC forms can be found at: https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Jaimes 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301
VISIT DATE: 08/04/2023
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Off-limits: Off-limit areas include all the bedrooms and bathroom #2 made inaccessible by door safety knobs. The laundry room is made inaccessible to children by door safety knob.

Others:
Per licensee and LPA’s observations, there are no bodies of water. Electrical outlets are covered and made inaccessible to children. There are two pets in the facility.

Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.
Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit is located in the day care room in a cabinet and was observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (2A10BC) reading in Green and currently serviced.

Medications/ Hazardous Materials: Medications are in the off-limits master bedroom, inaccessible by safety knob. Per licensee, there are No Firearms at the facility at this time. The facility currently does have childcare insurance.

Incidental Medical Services (IMS): 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 Licensee will not be providing IMS to the children at this time.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301
VISIT DATE: 08/04/2023
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Main Care Area: Main care is provided in the in the converted garage. Children use the bathroom located on the hallway of the home in the right-hand side. Children have access to the kitchen and backyard. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises of this facility. Per licensee, there is a designated area for ill/sick children in the living room area. Children nap in the day care room in mats properly stored.

Children's bathroom: Children use the bathroom located in the hallway on the right-hand side. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition. Toilet and faucets are clean, safe, and operable. LPA observed safety latch in the cabinets where cleaning products are kept.



Kitchen/Dining Room: The kitchen does not have a physical barrier. LPA observed some of the cabinets with a safety latch. Sharp knives are inaccessible and kept in an upper cabinet. Cleaning compounds were observed to be kept in a lower cabinet in the kitchen with a broken safety latch. A Type A citation was issued for this violation. Per licensee, she does currently have a food program.

Backyard/Outdoor areas: The backyard is completely fenced (cement block). LPA inspected and observed the backyard to be free of hazards, lose or sharp parts and tools. LPA observed appropriate and safe toys in the play area. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301
VISIT DATE: 08/04/2023
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LPA discussed the safe sleep regulations with licensee Jaimes 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 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.

Inspection was conducted in Spanish; LPA is certified as bilingual by the department.

The facility was cited 1-Type-A deficiency and 3 Type B deficiencies as of result of the violations in accordance with Title 22 of the California Code of Regulations. Facility was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of infants currently and newly enrolled at the facility during the next 12 months and facility must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each infant’s file. If these requirements are not met, civil penalties per violation will be assessed.

Exit interview conducted and report was sent electronically to licensee Jaimes, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/07/2023 08:39 AM - It Cannot Be Edited


Created By: Barbara Beneroso On 08/04/2023 at 01:27 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: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed in the kitchen a cabinet that contained cleaning products with broken safety latch,. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2023
Plan of Correction
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Licensee will provide proof of safety latch installed to LPA Beneroso no later than 08/04/2023
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:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/07/2023 08:39 AM - It Cannot Be Edited


Created By: Barbara Beneroso On 08/04/2023 at 01:27 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: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA observed incomplete Infant Sleep Logs, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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Licensee will submit proof of Infant Sleep Logs for all infants to LPA Beneorso no later than 08/18/2023
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA did not observe an employee file for one of the assistants, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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Licensee will submit proof of assistan's file to LPA Beneorso no later than 08/18/2023
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:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 08/07/2023 08:39 AM - It Cannot Be Edited


Created By: Barbara Beneroso On 08/04/2023 at 01:27 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: JAIMES, ADELA FAMILY CHILD CARE
FACILITY NUMBER: 153907301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.2(a)
Reporting Requirements
(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA observed a converted porch in which children were present with no permits and no notification to the department of such change, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2023
Plan of Correction
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Per LIcensee, she will cease the use of the converted porch immediately.
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:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023


LIC809 (FAS) - (06/04)
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