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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700099
Report Date: 07/11/2024
Date Signed: 07/11/2024 04:39:51 PM

Document Has Been Signed on 07/11/2024 04:39 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:PANTOJA FAMILY CHILD CAREFACILITY NUMBER:
157700099
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
07/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:David PantojaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 07/11/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Annual Random inspection at the Pantoja Family Child Care Home. Upon arrival, the LPA met with licensee, David Pantoja who guided LPA on a tour of the facility. Family members residing in the home include 4 adults and no minor children. All adults living in the house have been background cleared. Per the Licensee, hours of operation are Monday through Friday 5AM to 5PM. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 3 children present. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a single-story home with 4 bedrooms and 3 bathrooms. Per licensee, care is primarily in bedroom #1 and #2 and backyard (divided). 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: Per licensee, care is primarily in bedroom #1 and #2 and backyard (divided). 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 one of the rooms. Children nap mats LPA observed nap equipment to be properly stored.

Children's bathroom: Children use the bathroom located in the hallway on 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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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: 07/11/2024
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Kitchen/Dining Room: The home is divided by one door, the kitchen is on the off limits side. The physical barrier is a mesh child safety gate. Sharp items are located in a drawer, secured with a safety latch. Per licensee, she does currently have a food program. Meals offered: Breakfast, AM Snack Lunch and PM snack.

Backyard/Outdoor areas: The backyard is all fenced in and currently divided into two, one for personal space and one for the children to play in. LPA observed one storage shed that remains locked. 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. LPA observed an above ground swimming pool that is divided from the children’s outdoor area by black wrought iron fence. The fence is currently measuring at 3 feet 10 inches. The openings in between the fence bars are measuring at 4 inches. There is one gate with a latch that is not self-locking or self-latching. The above pool does have an accessible ladder. LPA cited a Type A Violation for this deficiency with a Civil Penalty of $500.

Off-limits: Per licensee, the off-limit areas of the home include the 2 bedrooms, one bathroom, kitchen, living room, dining area and garage. The backyard is divided into two, one for personal use and one for children to play in. Rooms and garage are made inaccessible by a safety door knob and by a child safety gate at the door that divides the home.



Care and Supervision: Licensee is within the ratio for a small facility. 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.

Medications/ Hazardous Materials: Medications are stored in the pantry. Cleaning compounds are stored in a lower cabinet in the bathroom and in the kitchen both secured with a safety latch. There are no firearms in the home.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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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: PANTOJA FAMILY CHILD CARE
FACILITY NUMBER: 157700099
VISIT DATE: 07/11/2024
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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 complete as well as the staff’s files. Licensee’s CPR/First Aid is maintained current, it expires on 04/2025. Mandated Reporter Certificate is also maintained current, it expires on 04/05/2025. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 02/21/2024. 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 Pantoja 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.

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

Megan’s Law - On this date, 07/11/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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: 07/11/2024
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MyChildCarePlan.org: Family Child Care Home Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Criminal Record Clearance: Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

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 One-Type-A deficiency and a $500 Civil Penalty as of result of the violations in accordance with Title 22 of the California Code of Regulations. 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 children 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 Children'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: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2024 04:39 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 07/11/2024 at 01:00 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: PANTOJA FAMILY CHILD CARE

FACILITY NUMBER: 157700099

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 07/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)(A)
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. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.

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 an above ground pool with a gate measuring 3 feet 10 inches and a safety latch that did not work properly which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2024
Plan of Correction
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Per licensee, he will unasemble the above ground pool and will completely remove it no later than 07/12/2024. Licensee agrees to send photo evidence of the pool being taken down via email to LPA Beneroso

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: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


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