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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700063
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:36:29 PM

Document Has Been Signed on 09/29/2022 04:36 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:MELVIN FAMILY CHILD CAREFACILITY NUMBER:
157700063
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
09/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Chunte Melvin, Licensee TIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Andrew Alemoh, Anna Villa and Licensing Program Manager (LPM) Mariela Ramon conducted a Case Management Inspection to conduct a license capacity increase. Upon arrival, LPAs met with licensee Chunte . Upon arrival, LPAs observed 3 infant, 1 preschool age child, and 2 school age children being supervised by the licensee and her assistant.

Licensee has requested to increase her license capacity from 8 to 14 children. The fire department has granted a fire clearance. Licensee is advised that as a family childcare home operating at full capacity, she must adhere to the following: Operate with a Maximum of 14 children in care with no more than 3 Infants, also must have 2 school age children enrolled. Or Max. 12 Capacity with no more than 4 infants. A Qualified Assistant must be present when more than 8 children are in care.

This is a one story 3 bedrooms, 2 bathroom home with kitchen, dining room, living room and attached garage. There is a detached structure which consists of a family room utilized as the children's playroom. There are no bodies of water on the premises. Family members residing in the home include the licensee and two children. Hours of operation are Monday through Sunday for less than 24 hours a day. Incidental Medical Services (IMS) policy was discussed. Licensee was reminded that when providing overnight care, licensee/assistant shall remain awake whenever children are awake. The door to room where provider is sleeping must remain open to observe children in care that are sleeping.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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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: MELVIN FAMILY CHILD CARE
FACILITY NUMBER: 157700063
VISIT DATE: 09/29/2022
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Licensee was also reminded that when providing overnight care for infants, the provider shall follow the requirements specified in Subsection 102425. A monitor device may be used in place of physically checking the infant every 15 minutes if the infant is sleeping and provider is going to sleep.

Physical Plant: The home is clean and orderly. Main care is provided in the living room, and the entire detached structured. Children use the bathroom in the hallway on the left side. Children nap on cots in the main day care area. Off limit areas include all bedrooms in the home, kitchen, two bathrooms and the attached garage.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink) and the bathroom children use to ensure there is no chemicals or hazards that can pose a danger to children. Per licensee, she does not have any medicines in the home. LPAs and LPM observed knives stored in kitchen cabinet with lock.

The smoke detector and carbon monoxide detector are in operable condition. LPAs observed the required fire extinguisher (2A10BC) is fully charged. The facility sketch is complete and current, there is working telephone (land line and cell). The facility roster is current. The fireplace is screened. The home has air condition/heating units in the rooms to provide a cool and warmer environment for the children.

Safe and age appropriate toys, play equipment and materials were observed. Electrical outlets are inaccessible. LPAs reminded licensee, no baby bouncer saucer chairs, or any recalled and or prohibited toys or sleep/play equipment are allowed on the premises.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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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: MELVIN FAMILY CHILD CARE
FACILITY NUMBER: 157700063
VISIT DATE: 09/29/2022
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Outdoor: Children play in the back yard. The play area is clear and clean of debris, play area is fenced and gated all around, play yard has grass for play time.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has CPR/First Aid 07/23/2021, CPR/First Aid will expire on 07/23/2023. . Mandated Reporter Training will expire on 11/10/2023. Review of records to be maintained: LPAs reviewed children's files and they were complete.

Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), Large and Small Child Care Ratio Packet, and Lead Poisoning flyer's.

The following were observed/discussed and or provided: Seat Belt Safety, Safe Sleep poster observed, forms required for children file (LIC311D), Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Staffing and Ratio (capacity limitations handout provided), Emergency and Disaster Information (LIC610A, LIC9148), Lead Flyer Requirement, liability insurance (LIC282) must have signed form on file if no liability insurance. Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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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: MELVIN FAMILY CHILD CARE
FACILITY NUMBER: 157700063
VISIT DATE: 09/29/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

PIN 22-01-CCLD dated 5/23/22

Individuals who hold a criminal record clearance or exemption must notify the Department within ten (10) calendar days of any change to their mailing address to ensure effective communication related to a criminal record clearance or exemption. Providers and Licensees are encouraged to ensure individuals on their employee/staff rosters are aware of this new requirement.

Individuals may update their mailing address with the Department in various ways, including: logging into their Guardian account; sending an email to Guardian@dss.ca.gov; calling the customer service line at 888-422-5669; sending a request to update by fax at (916) 754-4589; or mailing the address change information to: Care Provider Management Bureau


744 P Street MS T9-15-62
Sacramento, CA 95814
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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