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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700112
Report Date: 02/15/2024
Date Signed: 02/16/2024 11:27:59 AM

Document Has Been Signed on 02/16/2024 11:27 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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
157700112
ADMINISTRATOR:DIAZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 436-3646
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Maria Diaz TIME COMPLETED:
03:00 PM
NARRATIVE
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On 02/16/2024 LPA Beneroso conducted a follow up visit after having computer issues that prevented LPA from collecting the signatures in the original report (LIC809 and LIC809-D). LPA observed 3 children present at the time of the visit. LPA went over the report with licensee again and a plan of correction was developed for the deficiencies.

On 02/15/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Random Inspection at the Family Child Care Home. Upon arrival, the LPA met with licensee, Diaz who guided LPA on a tour of the facility. Family members residing in the home include 1 adults (licensee) and no minor children. All adults living in the house have been background cleared. Per the Licensee, hours of operation are Monday through Saturday 5:00am – 11pm for less than 24 hours. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 4 children and two infants in care Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a single-story home with 5 bedrooms and 3 bathrooms. Per licensee, care is provided primarily in converted garage (with permits), dining area, living room and backyard. 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 converted garage(playroom) and dining area. Children use the bathroom located in the converted garage. 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 a corner in the playroom.

Napping: Children nap in the playroom in cots. Infants sleep in play pens. Upon arrival, LPA observed an infant sleeping with blanket partially covering his face. In addition, LPA observed a second blanket close to the infant, one toy and the infant’s bottle in the playpen. A Type B citation was issued during the inspection for this violation. LPA requested Infant Sleep Logs for the two infants present but they were not available. Per licensee, she was not aware of the regulation. A Type B citation was issued during the inspection for this violation

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
Document Has Been Signed on 03/06/2024 09:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/16/2024 11:05 AM


Created By: Barbara Beneroso On 02/15/2024 at 04:51 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

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 laundry detergent in the in a lower cabinet in the children's bathroom (broken latch) and floor cleaning product in the bathtub which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2024
Plan of Correction
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Licensee removed all cleaningn products from the lower cabinet with a broken safety latch and from the bathtub during inspection.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 03/06/2024 09:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/16/2024 11:08 AM


Created By: Barbara Beneroso On 02/15/2024 at 04:51 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

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 one bedroom door with no doorknob and no other mechanism to close keep the door locked and one bedroom door unlocked, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Per licensee, she agrees to have doors fixed and locked no later than 02/09/2024
Type B
Section Cited
CCR
102417(g)(9)(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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

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. Per licensee, she does not document fire drills, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Per licensee, she agrees to conduct fire drills every 6 months and to document the drills in a form. Licensee agrees to conduct the fire drill and complete form no later than 02/09/2024
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: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 03/06/2024 09:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/16/2024 11:10 AM


Created By: Barbara Beneroso On 02/15/2024 at 04:51 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

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. Upon arrival to the facility, LPA observed an infant in a playpen with two blankets, a baby bottle and a toy, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2024
Plan of Correction
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LPA observed licensee remove items from the infants crib during inspection.
Type B
Section Cited
CCR
102425(j)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Licensee disclosed she does not keep a log for infants when they nap and disclosed she is not aware of Safe Sleep Regulations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Licensee agrees to check and document every 15 minutes when infants nap. Licensee agrees to have these logs available for review no later than 02/29/2024
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: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 03/06/2024 09:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/16/2024 11:12 AM


Created By: Barbara Beneroso On 02/15/2024 at 04:51 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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 vaccination records for ilcensee's assistant which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Licensee agrees to have assistant's file complete with vaccination records no later than 02/29/2024
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 and record review, the licensee did not comply with the section cited above. LPA observed an incomplete Consent to Emergency Medical Care in one of the children's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Licensee agrees to have children's complete records no later than 02/29/2024
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: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 03/06/2024 09:22 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/16/2024 11:13 AM


Created By: Barbara Beneroso On 02/15/2024 at 04:51 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at 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. Per licensee, she does not have LIC9227 in one of the infant's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Licensee agrees to have LIC9227 in Infant's file no later than 02/29/2024
Section Cited
Deficient Practice Statement
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POC Due Date: 02/29/2024
Plan of Correction
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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: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 6 of 7
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112
VISIT DATE: 02/15/2024
NARRATIVE
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Children's bathroom: Children use the bathroom located in the playroom. The bathroom was toured and inspected, sink and toilet were observed to be in operable condition. During inspection, LPA observed a lower cabinet with a faulty safety latch where laundry detergent was found to be accessible to children. LPA also observed the bathtub in the child’s bathroom to have a floor cleaning product within reach of children. A type A Citation was issued for this violation.

Kitchen/Dining Room: The kitchen has a physical barrier; a child safety gate was observed to be installed. Sharp items were observed to be in a kitchen drawer, secured with a safety latch. Per licensee, she does currently have a food program. Meals offered: Breakfast, AM Snack, Lunch, PM Snack and Dinner. Kitchen’s cleaning compounds are stored in a lower cabinet in the kitchen, secured with a safety latch and a child safety gate.

Backyard/Outdoor areas: The backyard is fenced all around with cement block. 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. Per licensee, there are no pets in the property. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises.

Off-limits: Per licensee, the off-limit areas of the home include the 5 bedrooms, two bathrooms. LPA observed two rooms in the hallway to be unlocked and accessible to children. One of the rooms was observed to not have a doorknob or any mechanism to prevent access to the room. A Type B Citation was issued for this violation.



Fireplace: The fireplace is located in the living room and was observed to be properly barricaded.

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

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112
VISIT DATE: 02/15/2024
NARRATIVE
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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 (3A40BC) 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.

Medications/ Hazardous Materials: Medications are stored in an upper cabinet in the kitchen, made inaccessible by a child safety gate. There are no firearms in the home.

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. LPA observed two children’s files with incomplete forms. Two children’s files were observed to have incomplete “Consent for Emergency Medical Treatment” forms and incomplete Parent’s Rights form in one of the children’s files. A type B Citation was issued for this violation. Infant’s files were also observed to be incomplete, LIC9227 “Individual Sleeping Plan” was missing form one of the infant’s files A type B Citation was issued for this violation. Sleep Logs were missing for two of the infants present. A type B Citation was issued for this violation see above.
Staff records were observed to be incomplete. Assistant’s vaccination records were missing from her file as well as the her Employee Rights. A type B Citation was issued for this violation.

Licensee’s CPR/First Aid is maintained current, it expires on 07/2025. Mandated Reporter Certificate is also maintained current, it expires on 05/13/2024. Per Licensee, fire and disaster drills are conducted every 6 months; however, the last drill was not documented. A type B Citation was issued for this Violation . Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112
VISIT DATE: 02/15/2024
NARRATIVE
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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 Diaz 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, 02/15/2024, 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.

MyChildCarePlan.org: 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.

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

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 157700112
VISIT DATE: 02/15/2024
NARRATIVE
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Inspection was conducted in Spanish, LPA is certified bilingual by the department.

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 one-Type-A deficiencies as of result of the violations in accordance with Title 22 of the California Code of Regulations and 7-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: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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