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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700099
Report Date: 07/13/2023
Date Signed: 07/14/2023 09:03:29 AM

Document Has Been Signed on 07/14/2023 09:03 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:PANTOJA FAMILY CHILD CAREFACILITY NUMBER:
157700099
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
07/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:David PantojaTIME COMPLETED:
01:45 PM
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On 07/13/23 Licensing Program Analyst (LPA) Beneroso conducted a Pre-licensing Inspection with Applicant David Pantoja who guided LPA on a tour of the facility. This is a one-story house with 5 bedrooms, 3 bathrooms, living room, kitchen, dining area laundry room and garage. Family members residing in the home include 3 adults (Applicant, Applicant’s cousins) and 2 minor children. The facility will operate Monday through Saturday from 5AM-5PM for less than 24 hours and with a license capacity of 8 children. LPA went over the childcare ratios for a small family home with applicant and provided applicant with a copy.

Main Care Area: Main care will be provided in bedroom#1 and bedroom #2. Children will nap in the bedroom #2 area. Children will eat in the dining room area. Per applicant he will apply for a food program. The day care children will utilize the hallway bathroom on the right-hand side of the home. Children will use the backyard for outdoor play time, the backyard is divided and barricaded one side for children’s outdoor playtime and the left side for private use.

There are no pools or bodies of water on the premises.

Off-Limit Areas: The front yard, bedrooms #3, #4 and #5, bathroom #2 and #3, laundry room, and garage area are off limits to the day care children and half of the backyard. LPA observed day care area to be clean and orderly, central air and heating, age-appropriate toys and play equipment.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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: PANTOJA FAMILY CHILD CARE
FACILITY NUMBER: 157700099
VISIT DATE: 07/13/2023
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Bathroom: LPA observed a clean, safe and operable toilet and faucet. LPA reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover.

Napping: Children will nap in bedroom #2, applicant will provide mats for naptime.

Backyard/Outdoor areas: LPA toured the backyard and observed it to be all fenced in with wooden fence. Children will have access to the back yard partially. Left side of the backyard is for private use, right side is for children’s outdoor playtime. There are 3 pets in the home. Per licensee, the are no firearms in the home and no one smokes in the home.

Fire/Health/Safety: LPA observe a fully charge 3A40BC fire extinguisher during the inspection located in the hallway in the daycare area. LPA observed a working smoke detector and carbon monoxide detector. The First Aid kit is located in the hallway (daycare area) and was observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. Electrical outlets are inaccessible to children. Per LPA’s observations, there were no hanging window blind cords. All windows are free of cracks, bugs, and debris. Applicant was informed smoking is prohibited, applicant stated no one smokes in the home, LPA discussed Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicant with a visual copy of prohibited items. LPA did not observe prohibited items during the inspection. Applicant was informed their cell phone shall be available and charged at all times during day care hours.

Medications/ Hazardous Materials: Medications are located in the off-limits master bedroom, locked with a safety door knob. Cleaning compounds were observed to be located in the kitchen secured with a safety latch. Per licensee, there are No Firearms at the facility at this time.


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

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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: PANTOJA FAMILY CHILD CARE
FACILITY NUMBER: 157700099
VISIT DATE: 07/13/2023
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Kitchen: LPA observed the kitchen area to be free of hazards. Applicant safety latched the kitchen drawers and kitchen cabinets. The following are inaccessible: Sharp items are stored in an upper kitchen cabinet inaccessible to children in care. LPA observed the refrigerator and freezer to be clean. LPA discuss with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent. Applicant do not have a food program at this time but will be joining a food program in the future.

Advisory/Other: Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Children will nap on cots and mats in the daycare area. Applicant aware no infant shall be swaddled, and car seat shall not be used for sleeping. Applicant is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the infant’s status. Applicant should refer to regulation 102425(J) for documentation requirement. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping.

Documents Provided and or Discussed: The following were provided to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), water lead poster, required postings and list of CCLD forms required for child file each child in care (LIC 311D).

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

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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: PANTOJA FAMILY CHILD CARE
FACILITY NUMBER: 157700099
VISIT DATE: 07/13/2023
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LPA discussed the safe sleep regulations with applicant, including Safe Sleep PIN 20-24-CCP and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant 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

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

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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: PANTOJA FAMILY CHILD CARE
FACILITY NUMBER: 157700099
VISIT DATE: 07/13/2023
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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: https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Incidental Medical Services (IMS): IMS policy was discussed, informing applicant when any IMS is provided, a plan for providing IMS must be submitted to the Department prior to providing care to a child that need IMS. The plan shall state the type of IMS the facility will be offering, stating the person providing care has been trained to provide the named IMS. The plan will also provide the steps that will be taken when IMS is provided to a child.

The following information regarding ADA was discuss and the following information 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

Based on LPA's observations, the facility is now in compliance with Tittle 22 Regulations and is ready for licensure effective 07/13/23

Exit interview conducted copy of this report was provided to applicants along with notice of site visit.

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

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC809 (FAS) - (06/04)
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