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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700119
Report Date: 03/15/2024
Date Signed: 03/15/2024 04:29:41 PM

Document Has Been Signed on 03/15/2024 04:29 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:WALLACE FAMILY CHILD CAREFACILITY NUMBER:
157700119
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Caren Wallace TIME COMPLETED:
02:45 PM
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On 03/15/24 Licensing Program Analyst (LPA) Beneroso conducted a Pre-licensing Inspection with Applicant Caren Wallace who guided LPA on a tour of the facility.

This is a one story house with 3 bedrooms, 3 and bathrooms, living room, kitchen, dining area, laundry area and converted garage. Family members residing in the home include two adults (Applicant and applicant's husband) and no minor children

The facility will operate Monday, Wednesday from 8:30AM – 12:30PM and 1PM to 4PM Tuesday and Thursday 8:30AM to 4:00PM. Fridays will be open as needed 8:30AM to 1:30PM 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 room #1 and possibly the “overflow Play room” if authorized by the department. Overflow play room is currently divided with a child safety gate. Children will also utilize the outdoor/covered patio as a classroom. Children will nap and eat in the day care room (bedroom#1). Per applicant she is not sure she will apply for the food program. The day care children will utilize the bathroom located next to the laundry area and the bathroom next to bedroom#1. Children will use the backyard for outdoor play time. LPA observed day care area to be clean and orderly, air conditioning and heating system was observed, age-appropriate toys and play equipment. There is a area for ill/sick children in bedroom#1. Children will nap in bedroom#1 if needed, per program hours . Mats will be stored in the closet of bedroom#1.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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: WALLACE FAMILY CHILD CARE
FACILITY NUMBER: 157700119
VISIT DATE: 03/15/2024
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Off-Limit Areas: The front yard, bedrooms 2 and 3 bathroom #3 are off limits to the children in care. LPA observed bedroom #2 door being locked and child safety gate in the area that gives access to the rest of the house.

Bathroom: LPA observed bathrooms to be 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.

Kitchen: LPA observed kitchen to be inaccessible and off-limits by a child safety gate located in the hallway.

Backyard/Outdoor areas: LPA toured the backyard and observed it to be all fenced with heavy gauge wire and wood. Access to the backyard is overflow playroom area and bedroom#1. There is one storage shed that remains locked. There is one pet in the home that will remain in the off-limits rooms.

Fireplace/Heaters: The pellet stove that is located in the overflow playroom that was observed to be properly barricaded. Per applicant, the pellet stove wont be used during day care hours.



Fire/Health/Safety: LPA observe a fully charge 3A40BC fire extinguisher reading in green and serviced. LPA observed a working smoke detector and carbon monoxide detector to be in working conditions. The First Aid kit is located the laundry area in an upper cabinet and was observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. The facility currently does have childcare insurance. 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 for infants. LPA did not observe prohibited items during the inspection. Applicant was informed their cell phone shall be available and charged at all times during daycare hours. Per licensee, the are no firearms in the home and no one smokes in the home.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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: WALLACE FAMILY CHILD CARE
FACILITY NUMBER: 157700119
VISIT DATE: 03/15/2024
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Medications/ Hazardous Materials: Medications are located in the off-limits master bathroom. Cleaning compounds were observed to be located in the laundry area in an upper cabinet.

Advisory/Other: Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. 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).

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.

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

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

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: WALLACE FAMILY CHILD CARE
FACILITY NUMBER: 157700119
VISIT DATE: 03/15/2024
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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

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: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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: WALLACE FAMILY CHILD CARE
FACILITY NUMBER: 157700119
VISIT DATE: 03/15/2024
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Based on LPA's observations, the facility is pending approval of overflow playroom in order to be licensed. LPA will follow up with management.

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: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
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