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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700060
Report Date: 11/08/2023
Date Signed: 11/09/2023 01:23:40 PM

Document Has Been Signed on 11/09/2023 01:23 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
157700060
ADMINISTRATOR:AIDA RIVASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 809-5834
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/08/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Aida RivasTIME COMPLETED:
02:00 PM
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On 11/08/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Rivas Family Child Care Home. Upon arrival, the LPA met with licensee, Aida Rivas who guided LPA on a tour of the facility. Family members residing in the home include 2 adults. All adults living in the house have been background cleared. Per the Licensee, hours of operation are a day Monday through Friday 5:30am – 10pm. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 7 children in care children in care and 3 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 single-story home with 3 bedrooms and 2 bathrooms with a kitchen, dining room, living room, a den and a detached garage that is maintained locked LPA observed door to be locked. The den is the primary location in which care is provided. 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 age appropriate safe toys and napping equipment on the premises.

Main Care Area: Main care is provided in the in the den (playroom). Children use the bathroom located in the hallway on the right-hand side (from main entrance). 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 living room. Children nap in day care care room) area in cots that are properly stored.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 11/08/2023
NARRATIVE
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Children's bathroom: Children use the bathroom located in the hallway on the right-hand side (from main entrance). 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 has a no physical barrier. Sharp items are located in an upper cabinet shelf inaccessible to children. Cleaning compounds are located in a lower cabinet. LPA observed safety latch to be not properly secured, giving access to cleaning compounds. A type A Citation was issued for this violation. Per licensee, she does currently have a food program. Meals offered: Breakfast, Lunch, PM Snack and dinners as needed.

Backyard/Outdoor areas: The backyard is gated all around. There is a pool that has partial iron fencing in one section. The rest of the pool is surrounded by the garage and chain linked fence. There is a section of the pool that has a small gate and windows that give access to the pool from the room utilized for day care (play room). LPA also observed the gate to the pool not self-latching. A Type A Citation was issued for this violation. The backyard is divided into two. One side for day care children and the other for personal use. LPA observed appropriate and safe toys in the play area. LPA reminded licensee that she must provide supervision at all times. Per licensee, there are no pets in the facility.

Off-limits: Per licensee, the off-limit areas of the home include 3 bedrooms, one bathroom, part of the backyard, detached garage and front yard.



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.

Medications/ Hazardous Materials: Per licensee, there are no medications in the facility. There are no firearms in the home.

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

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 11/08/2023
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Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Rivas 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 Rivas 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.

There are no deficiencies cited during today’s inspection. Exit interview conducted and report was reviewed with the licensee Rivas, along with her appeal rights and Notice of Site Visit.

The facility was cited 2-Type-A deficiencies as of result of the violations in accordance with Title 22 of the California Code of Regulations and 2-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: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 11/08/2023
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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 (2A10BC) 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.
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 LIC627 was missing from two files. A type B Violation was issued for this deficiency. Assistants’ files were incomplete. One of the assistants present did not have a file in the facility. A type B Violation was issued for this deficiency. Licensee’s CPR/First Aid is maintained current, it expires on 04/2025. Mandated Reporter Certificate is also maintained current, it expires on 11/07/2025. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 10/02/2023. 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.

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

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

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/09/2023 01:23 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 11/08/2023 at 01:17 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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023

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 safety latch in lower cabinet in the kitchen where cleaning products are located to be not secured, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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LPA observed licensee put the cleaning compounds in the laundry room during inspection.
Type A
Section Cited
CCR
102417(g)(5)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

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 pool gate not to be self-latching and two windows that give access to the pool, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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LPA observed door safety knob being in placed in door that gives access to the backyard and screws being installed during inspection.
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: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/09/2023 01:23 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 11/08/2023 at 01:17 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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

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 one of the assistants present, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Licensee agrees to send proof of complete files to LPA Beneroso no later than 11/22/2023
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

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 observed the Concent to Emergency Medical Care for two children, which poses/posed a potential health, safety or personal rights risk to persons in care
POC Due Date: 11/22/2023
Plan of Correction
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Licensee agrees to send proof of complete files to LPA Beneroso no later than 11/22/2023
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: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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