153908922-9-27-2023-12-CC-BBEO-CW3KXR-20230927081759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153908922
Report Date: 09/26/2023
Date Signed: 09/27/2023 08:19:25 AM

Document Has Been Signed on 09/27/2023 08:19 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:	SIERRA, ROSA FAMILY CHILD CARE		FACILITY NUMBER:	153908922
ADMINISTRATOR:	SIERRA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 854-0272
CITY:	ARVIN	STATE: CA	ZIP CODE:	93203
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	09/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:39 PM
MET WITH:	Rosa Sierra		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/26/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Sierra Family Child Care Home. Upon arrival, the LPA met with licensee, Rosa Sierra who guided LPA on a tour of the facility. Family members residing in the home include 3 adults (licensee and licensee’s spouse and licensee’s son) and licensee’s 2 minor children. All adults living in the house have been background cleared. Per the Licensee, hours of operation are a day Monday through Friday is 24 hrs. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 7 day care children in care and the 2 adults providing care and supervision. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed. Physical Plant: This is a one-story, 4-bedrooms, 2-bathrooms home with a kitchen, living room, dining area, backyard, garage and laundry area . 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. There are no cords hanging from the windows. All electrical outlets are covered. Main Care Area: Main care is provided in the in the living room and dining area. Children use the bathroom located on the hallway on the left-hand side. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises. Per licensee, there is a designated area for ill/sick children in the dining area (day care area). Children nap in the living room area in cots that are properly stored. Children's bathroom: Children use the bathroom located in the hallway on the left-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. There are cleaning products kept in the bathroom in a lower cabinet, secured with a safety latch.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 5

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: SIERRA, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 153908922
	VISIT DATE: 09/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Kitchen/Dining Room: The kitchen has a physical barrier. LPA observed a child safe gates installed. Sharp items are kept in an upper cabinet. Cleaning compounds are stored in a lower cabinet, made inaccessible child safety gate and safety latch. Per licensee, she currently participates in a food program. Meals offered: Breakfast, AM snack, Lunch, and PM Snack.

Fireplace: There is a fireplace located in the living room that is not currently connected and is properly screened.

Backyard/Outdoor areas: The backyard is completely fenced (cement blocks). The backyard has play equipment that is safe and in well repair. The backyard was found to be clean, free of debris or harmful materials. The backyard is divided into two, one side for personal use and the other side is used for day care children. There is a storage shed that remains locked and is on the off-limits side of the property. Per licensee and LPA’s observations, there are no bodies of water in the premises. There are no pets in the home.

Off-limits: Off-limit areas include all the bedrooms of the home, bathroom #2, garage and partially the backyard. The laundry equipment is located in the garage. LPA observed all doors of off-limit bedrooms to have a safety doorknobs.

Care and Supervision: Licensee is within the ratio for a large facility. The Licensee was reminded that supervision is always required for children in care.

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 was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (3A40BC) reading in Green and currently serviced. The facility currently does not have childcare insurance.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: SIERRA, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 153908922
	VISIT DATE: 09/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Medications/ Hazardous Materials: Medications are stored in the master bedroom, made off-limits and secured with a safety doorknob. Cleaning compounds were observed to be kept in the garage, locked and secured with safety doorknob. Per licensee, there are No Firearms at the facility.

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.

Records: Children’s records were observed to be complete and current. Assistant’s files were found to be incomplete. A Type B violation was issued during inspection.
Licensee’s CPR/First Aid is maintained current, it expires on 07/22/2025. Mandated reporter is maintained current, but no proof of Mandated Reporter was kept. Licensee will provide proof of Certificate no later than 09/29/2023. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 05/01/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and LIC9227 (Individual Sleeping Plan).

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: 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: SIERRA, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 153908922
	VISIT DATE: 09/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensee Sierra 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.

LPA discussed the safe sleep regulations with licensee Sierra and discussed the Child Care Licensing Safe Sleep webpage at 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 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 bilingual by the department.

One Type B Violation and One Technical Violation was issued during today’s inspection. A notice of site visit was provided to licensee and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Sierra, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 09/27/2023 08:19 AM - It Cannot Be Edited

Created By: Barbara Beneroso On 09/26/2023 at 01:21 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: SIERRA, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 153908922
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above. Assistant's file was missing Employee Rights and Immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/29/2023
	Plan of Correction
1 2 3 4	Licensee will submit proof of assistan's file (photos) complete with all the required forms by 09/29/2023

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5