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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700046
Report Date: 01/08/2024
Date Signed: 01/09/2024 08:09:07 AM

Document Has Been Signed on 01/09/2024 08:09 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:MALDONADO FAMILY CHILD CAREFACILITY NUMBER:
157700046
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lorena MaldonadoTIME COMPLETED:
02:45 PM
NARRATIVE
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On 01/08/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Maldonado Family Child Care Home. Upon arrival, the LPA met with licensee’s spouse and daughter (assistants) who guided LPA on a tour of the facility. Licensee Lorena Maldonado arrived shortly after. Family members residing in the home include 3 adults (licensee, Licensee’s husband and licensee’s father). Per the Licensee, hours of operation are Monday through Saturday 5:00am – 5pm. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 10 children in care children in care. Licensee is not within the ratio for a small facility A Type A Violation was issued for this deficiency. Incidental Medical Services (IMS) were discussed. The assistant present at time of visit did not have a background clearance. A Type A Deficiency was cited for this deficiency and a civil penalty was issued.

Physical Plant:
This is a single-story home with 4 bedrooms and 2 bathrooms. Per licensee, care is provided primarily in the living room, bedroom #1, dining room, bathroom (located at the end of the hallway) and backyard. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed cleaning compounds in the kitchen to be accessible to children. A Type A Deficiency was cited for this violation. LPA observed age appropriate safe toys and napping equipment on the premises.

Main Care Area: Main care is provided in the in the living room, bedroom #1 and dining area. Children use the bathroom located on the hallway. 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 a corner in the living room. Children nap in the living room (day care room) area in cots that are properly stored.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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Document Has Been Signed on 01/09/2024 08:09 AM - It Cannot Be Edited


Created By: Barbara Beneroso On 01/08/2024 at 02:12 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: MALDONADO FAMILY CHILD CARE
FACILITY NUMBER: 157700046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(c)
Staffing Ratio and Capacity
(c) The total licensed capacity for a Small Family Child Care Home shall not exceed eight 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 10 children present during visit which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/08/2024
Plan of Correction
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LPA observed two children leave the facility during inspection. Violation cleared durin visit.
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: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2024 08:09 AM - It Cannot Be Edited


Created By: Barbara Beneroso On 01/08/2024 at 02:12 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: MALDONADO FAMILY CHILD CARE
FACILITY NUMBER: 157700046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024

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], the licensee did not comply with the section cited above. LPA observed all door of off limit bedrooms unlocked and open. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/08/2024
Plan of Correction
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LPA observed doors being locked during inspection. Violation cleared during visit.
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 and record review, the licensee did not comply with the section cited above. LPA did not observe a file for licensee's assistant which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
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Licensee agrees to have assistant's file complete no later than 01/22/24
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: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 01/09/2024 08:09 AM - It Cannot Be Edited


Created By: Barbara Beneroso On 01/08/2024 at 02:12 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: MALDONADO FAMILY CHILD CARE
FACILITY NUMBER: 157700046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

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 did not observe a file for a child that was recently enrolled which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
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Licensee agrees to have all chldren's files complete by 01/22/24.
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: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024


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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: MALDONADO FAMILY CHILD CARE
FACILITY NUMBER: 157700046
VISIT DATE: 01/08/2024
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Children's bathroom: Children use the bathroom located in the hallway. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition.

Kitchen/Dining Room: The kitchen does not have a physical barrier. Sharp items are located above the refrigerator. LPA Observed cleaning products in a lower cabinet. A Type A Citation was issued (as previously mentioned) Per licensee, she does currently have a food program. Meals offered: Breakfast, Lunch, dinner and Snacks.

Backyard/Outdoor areas: The backyard is fenced in with cement block. The outdoor play area was inspected and was observed to be free of hazards, lose or sharp parts and tools. LPA observed appropriate and safe toys in the play area. Per licensee, there are no pets in the property. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises.

Off-limits: Per licensee, the off-limit areas of the home include the 3 bedrooms and one bathroom. LPA observed the master bedroom’s door completely open during inspection. LPA also observed all bedrooms of the home to be unlocked, making them accessible to children. A Type B Violation was issued for this deficiency. Laundry room and garage are also off limits and are kept locked during business hours.

Care and Supervision: Licensee is not within the ratio for a small facility, A Type A Violation was issued for this deficiency (see above). 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. Per licensee, she currently does offer transportation, LPA observed insurance to be current.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
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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: MALDONADO FAMILY CHILD CARE
FACILITY NUMBER: 157700046
VISIT DATE: 01/08/2024
NARRATIVE
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Medications/ Hazardous Materials: Medications are stored in an upper cabinet. Cleaning compounds are stored in a lower cabinet in the kitchen which was observed to have an unlocked safety latch, making cleaning compounds accessible. A Type A citation was issued for this deficiency (see above). There are no firearms in the home.

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 incomplete one child present did not have a file at the facility. A type B Violation was issued for this deficiency. Licensee’s assistant did not have a file. A Type B Violation was issued for this deficiency. Licensee’s CPR/First Aid is maintained current, it expires on 12/2025. Mandated Reporter Certificate is also maintained current, it expires on 02/27/2025. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on /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: Safe Sleep PIN 20-24-CCP and LIC9227 (Individual Sleeping Plan) and Sleep Logs. LPA discussed the safe sleep regulations with licensee Maldonado 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
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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: MALDONADO FAMILY CHILD CARE
FACILITY NUMBER: 157700046
VISIT DATE: 01/08/2024
NARRATIVE
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Provider Information Notices (PINs) & Child Care Advocates: You can now sign up for Quarterly Updates on Rules, Regulations, Policies and PINs for one or more programs through our DSS website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe Applicant was informed all forms pertaining to Child Care Licensing can be found at https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Child Care Advocates Program: Provides information and resources about licensed childcare. www.childcareadvocatesprogram@cdss.ca.gov

Inspection was conducted in Spanish, LPA is certified bilingual by the department. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Maldonado 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.

Applicant was advised 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 days of incident to the department. Applicant was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

The facility was cited 3-Type-A Violations as of result of the violations in accordance with Title 22 of the California Code of Regulations and 3-Type B deficiencies. 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.

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

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC809 (FAS) - (06/04)
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