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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192011078
Report Date: 10/13/2023
Date Signed: 10/13/2023 02:58:48 PM

Document Has Been Signed on 10/13/2023 02:58 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:ZALDANA FAMILY CHILD CAREFACILITY NUMBER:
192011078
ADMINISTRATOR:ZALDANA, MARIA GLADYSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 834-4636
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Maria Gladys ZaldanaTIME COMPLETED:
03:15 PM
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On 10/13/2023 Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was granted entry by Licensee who guided the LPA on a tour of the home. Upon entry to the facility LPA observe five children in care and two staff providing care and supervision.

This is a one-story family home with an attached garage. There is a living room, dining room, kitchen, three bedrooms, three restrooms, laundry area, family room and a back yard for outdoor play. Main care is provided in the family room, referred to as the childcare area. Children utilize one restroom located in the family room. The Children are provided with cots, infants are provided with individual cribs for napping. The infants have a separate room for napping with cribs, LPA reminded licensee while napping infant napping room door is required to be fully opened and infant shall be visible without moving the door. The off-limits areas the three bedrooms, two restrooms, kitchen, dining room, livening room attached garage (maintained locked), and the laundry room. LPA observed a screen door barricading the main home from the family day care area.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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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Document Has Been Signed on 10/13/2023 02:58 PM - It Cannot Be Edited


Created By: Isabel Ortega On 10/13/2023 at 01:22 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: ZALDANA FAMILY CHILD CARE
FACILITY NUMBER: 192011078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review], the licensee did not comply with the section cited above... last documentation on file is dated 07/03/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
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Licensee will immediately begin to document every 15 minutes while infant is napping in a log and observe infant for breathing, color and restlessness according to the PIN regulations on safe sleep. Licensee will submit a copy of the completed logs to the Palmdale Regional Office by 11/3/2023 by email, fax, or text.
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:Lady King
LICENSING EVALUATOR NAME:Isabel Ortega
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023


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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: ZALDANA FAMILY CHILD CARE
FACILITY NUMBER: 192011078
VISIT DATE: 10/13/2023
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Licensee participates in the food nutrition program and provides children with breakfast, morning snack, lunch, and afternoon snack. The hours of operation are Monday through Friday from 7:00 a.m. to 5:30 p.m. and Saturday from 8:00 a.m. 4:30 p.m.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Knives, medication, cleaning supplies and chemicals are kept inaccessible to children

There are educational age-appropriate toys and equipment on the premises.
The First Aid kit with a temperature thermometer was observed and complete. The required fire extinguisher (2A10BC) is reading in green (serviced 7/21/2023. There was a smoke detector and carbon monoxide detector tested at 1:10 p.m. and are working properly according to the fire marshal standards and codes. Fire and disaster drills are conducted every six-month. Last drill was conducted on 10/05/2023 at 10:00 a.m.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148)
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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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: ZALDANA FAMILY CHILD CARE
FACILITY NUMBER: 192011078
VISIT DATE: 10/13/2023
NARRATIVE
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The licensee maintains proof of immunization against pertussis (TDAP), measles (MMR), and influenza. Technical violation was given for missing Assistant’s immunization (MMR, Tdap(pertussis) and Tuberculous(TB) on file and on the premises.
Licensee provided a valid CPR/First Aid pediatric training certificate and does not expire until 11/17/2024. Child Care Provider Mandated Reporter training (AB1207) is required to be renewed every two-years. Licensee provided Child Care Provider Mandated Reporter (AB1207) training certificate dated 09/06/2024.

Technical violation was given for missing children’s physician information (name and phone number) and documented on Roster LIC9040 form. Licensee will maintain child roster current and up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.
The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your (LPA) of any person who will be visiting regularly or for longer than one week.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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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: ZALDANA FAMILY CHILD CARE
FACILITY NUMBER: 192011078
VISIT DATE: 10/13/2023
NARRATIVE
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The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

Safe Sleep regulations (under 24 months) were discussed with Licensee and referred to the CCL web site for additional information and PINS. Provided licensee with an infant sleep plan form LIC 9227 (infants under one year of age) and sleep log for 15-minute checks for infants under two years of age. A Type B citation will be issued for not complying to document while infants is napping every 15 minutes per safe sleep regulation up to age 2 years.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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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: ZALDANA FAMILY CHILD CARE
FACILITY NUMBER: 192011078
VISIT DATE: 10/13/2023
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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 following information regarding ADA 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 Child Care Advocates:

To sign up for our Quarterly Updates please email the Child Care Advocates at chilcareadvocatesprogram@dss.ca.gov & (916) 654-154.



The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000.

The facility was not found to be in compliance per Title 22 regulations, one deficiency will be cited today and technically violations were given today as a preventative for Staff files and child files. Prior to accepting a child in care, children's immunization and licensing forms must be on file with licensee. Infant room must keep door fully opened to visible observe infant while napping without having to move the door and a staff or a camera monitor shall be in place while infant is in the room napping.

An exit interview was conducted, a copy of this Report, a Notice of Site visit and Appeal rights were provided and discussed with licensee. All licensing reports are recommended to keep for 3 years, and the Notice of Site visit is to be posted visible to parents for 30 days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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