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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412430
Report Date: 07/27/2021
Date Signed: 07/27/2021 12:55:56 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/27/2021 12:55 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:VELASCO FAMILY CHILD CAREFACILITY NUMBER:
197412430
ADMINISTRATOR:VELASCO, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
6619443066
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Bertha VelascoTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Thompson-Miller met with Licensee Bertha Velasco who guided analyst on a tour of the facility for an One Year Required Inspection. Present today are licensee, one assistant and 10 day care children (3 infants, 1 school aged, 6 preschool). Family members residing in the home are three adults (licensee, two adult renters who utilize the separate section of the house property-separated by a common wall which is the off limits television room). Licensee shall provide a detail facility sketch of the property address to Community Care Licensing due to the separation of the property. This is a single level home with bedrooms and 3 bathrooms, lanundry area (outside porch area), nap room, office, living room, dining, kitche (no stove). The home (property address) consists of three bathrooms (one child care-changing table, toilet and sink, two off limits-one licensee, one private section), one kitchen (no stove-child care at entrance), living room and dining room (child care), napping room for infants, laundry area and carport. Next to the napping room is an off limits (key lock) bedroom. Off limits are licensee office, bedroom, television room and bathroom which are located to the right of the child care bathroom (key lock). The private section of the property has one bedroom, one bathroom, living room and kitchen. Adults residing at this separate section are fingerprint cleared and associated to the license. This section of the property has a separate driveway entrance and main entrance. There is no pool, spa or other bodies of water on the premises. Operating days and hours are Monday through Sunday 3am to 2am. Incidental Medical Services (IMS) was discussed.

Physical Plant: Main care is in the living and dining rooms (at entrance), bedroom #1 (infant nap room). The kitchen does not have a stove. Child care areas (living and dining room, bathroom, backyard play area) were toured. LPA also toured the entire property for clarification of the facility sketch provided to Child Care Licensing. All unused electrical outlets are plugged and age appropriate play equipment and toys are available. Licensee also understands the ratio and capacity requirements of the small and large family license. Licensee is aware she must be the primary caregiver and provide full care and supervision to children in care at all times.

All cabinets in the day care area have magnet locks. The home was inspected inside and out for safety, comfort, medication and hazardous items (sharp knives--cabinet with magnet lock) that can pose a danger to children. Children nap on cots and playpens. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. The home is clean and orderly. There is a designated area for ill children as necessary in the day care room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. There are no weapon/firearms in the home. Licensee has a working telephone (land line and cell).

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 197412430
VISIT DATE: 07/27/2021
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Kitchen/bathroom: Bathroom is free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean and operable, home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are under the sink (magnet lock). No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, dinner and snacks are provided.

Outdoor: The backyard (cement, dirt, grass artifical) is completely fenced. There are two swing sets (anchored), gated area on the left and rear section - off limits, Little Tikes play equipment, garden, marry-go-round, other age appropriate toys and a large shade covered area. The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises. Children wash hands outside faucet area.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid 06/22/2023. Mandated Reporter expire 6/18/2023. Electrical outlet are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. No Window cords throughout the home observed. There is cushioning or resilient material around the play structures (dirt, grass).

Documents Provided and or Discussed: The following were observed to be in regulation of Title 22 requirements: Fire Drill Log is current, Roster is up to date, Postings were observed and meet Title 22 requirements, COVID-19, Safe Sleep and Lead Poisoning flyer's observed Staffing and Ratio in regulation. Licensee stated currently does have child care insurance.

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.


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
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 197412430
VISIT DATE: 07/27/2021
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The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed; Licensee were reminded that 100% supervision is required at all times to children in care; Licensee were made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Licensee was advised of the requirement 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 LIC624B when submitting the report to the department.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

No deficiencies. Exit interview conducted and a copy of this report was read and provided to Licensee Bertha Velsco on this date.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
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