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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700074
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:32:32 PM

Document Has Been Signed on 10/12/2023 03:32 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:JAIME FAMILY CHILD CAREFACILITY NUMBER:
157700074
ADMINISTRATOR:AYDE JAIMEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 436-9414
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Ayde JaimeTIME COMPLETED:
01:40 PM
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On 10/12/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Jaime Family Child Care Home. Upon arrival, at 10:35AM, LPA met with an assistant who guided LPA on a tour of the facility. Ms. Ayde Jaime arrived 20 minutes later at 10:55AM. Adult residing in the home include 3 adults (Licensee, licensee’s assistant and assistant’s husband). Two adults living in the house have been background cleared, one adult has not been cleared. A Type A deficiency was issued during inspection for this deficiency. A civil penalty was also issued during inspection for this violation. Per the Licensee, hours of operation are a day Monday through Friday 5am – 6pm. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 8 day care children in care and the one adult providing care and supervision. At the time of inspection, Licensee was out of ratio since one of the children was not age of 6, school age or currently enrolled in school. Licensee was out of ratio for one child. A Type A violation was issued during inspection for this deficiency. Licensee arrived at 10:55am putting her back in ratio. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a one-story, 2-bedrooms, 2-bathrooms home with a kitchen, living room, dining area, backyard, detached garage, and laundry room. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. 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 living room, dining area and bedroom #1. Children use the bathroom located on room #1 (child Care Room). LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises. There are cubbies located near the main entrance labeled with children’s names. Per licensee, there is a designated area for ill/sick children in a small bed in the hallway. Children nap in the living room area and bedroom #1 in mats that are properly stored.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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: JAIME FAMILY CHILD CARE
FACILITY NUMBER: 157700074
VISIT DATE: 10/12/2023
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Children's bathroom: Children use the bathroom located in room #1. 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 as a physical barrier, a baby gate has been installed. Cleaning compounds are stored in a lower cabinet, made inaccessible by the child safety gate. Per licensee, she does currently have a food program. Meals offered: Breakfast, AM snack, Lunch, PM Snack and Dinner.

Backyard/Outdoor areas: The backyard is completely fenced (cement block. The backyard has play equipment that is safe and in well repair. There is a storage shed that remains locked. 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 bedroom #1, bathroom #2, detached garage and laundry room. LPA observed all doors of off-limit bedrooms to have a safety doorknob.



Care and Supervision: Licensee was out of ratio for a license with capacity of 14, due to only one assistant being present at the time LPA arrived. Eight Children were present. A type B Citation was issued during inspection. (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 have childcare insurance. Per licensee, she currently offers transportation. LPA observed vehicle’s valid insurance and driver's license.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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: JAIME FAMILY CHILD CARE
FACILITY NUMBER: 157700074
VISIT DATE: 10/12/2023
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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 a lower cabinet in the kitchen made inaccessible by child safety gate. 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 incomplete. There was no file for one of the children present in the home. One type B Deficiency was cited for this deficiency. One of the infants was missing the Safe Sleep Log. A type B citation was issued for this deficiency. Assistant’s files were observed to be complete.

Licensee’s CPR/First Aid is maintained current, it expires on 04/10/2024. Mandated Reporter Certificate is maintained current, expiration day is 07/18/2025. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 09/19/2023. 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

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: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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: JAIME FAMILY CHILD CARE
FACILITY NUMBER: 157700074
VISIT DATE: 10/12/2023
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Licensee Jaime 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 Jaime 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.

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.

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

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

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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Document Has Been Signed on 10/12/2023 03:32 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 10/12/2023 at 12:30 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: JAIME FAMILY CHILD CARE
FACILITY NUMBER: 157700074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2023
Plan of Correction
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Licensee agrees to make adult resident to obtain fingerprint cleareance/ live scan no later than 10/16/2023.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, the licensee did not comply with the section cited above. Licensee was out of ratio. Eight children were observed to be present, one of them were age of 6, school age or currently enrolled in school which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/12/2023
Plan of Correction
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Licensee arrived during inspection, putting her back on ratio.
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: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/12/2023 03:32 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 10/12/2023 at 12:30 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: JAIME FAMILY CHILD CARE
FACILITY NUMBER: 157700074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

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. Licensee did not keep record of Sleep Logs for one of the Infants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2023
Plan of Correction
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Licensee agrees to send LPA Beneroso proof (pictures) of infant's sleep logs no later than 10/20/2023.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

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. Licensee did not keep record of one of the children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2023
Plan of Correction
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Licensee agrees to send LPA Beneroso proof (pictures) of child's complete file no later than 10/20/2023.
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: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


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