197412963-10-13-2023-12-CC-AVIA-CWKQY2-20231013123426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412963
Report Date: 10/13/2023
Date Signed: 10/13/2023 12:34:46 PM

Document Has Been Signed on 10/13/2023 12:34 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:	ESPINOSA FAMILY CHILD CARE		FACILITY NUMBER:	197412963
ADMINISTRATOR:	ESPINOSA, LUCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 533-7346
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	10/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Lucy Espinosa, Licensee		TIME COMPLETED:	12:45 PM

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On October 13, 2023, Licensing Program Analyst (LPA) Annelise Villa met with Licensee Lucy Espinosa, who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival, LPA observed 5 children 2 infants and 3 preschool aged children in care. Adults living in the home are the licensee, licensee’s husband, and Licensee’s adult son. Hours of operation are Monday-Friday, 7:00am-5:00pm. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: This 2 story, 4-bed, 3-bath with family room, kitchen, laundry room front yard, back yard, and garage. Main care is provided in the family room and bedroom #1. Children use the bathroom off the hallway on the right. Children have access to the main care areas and the back yard. Off limit areas include all upstairs bedrooms, bathrooms #2-3, laundry room, front yard, and garage. LPA observed an operable safety gate barricading staircase. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons. Cleaning supplies, medications and alcohol were inaccessible to children in care.

Safe and age-appropriate toys, play equipment and materials were observed. The smoke and carbon monoxide detectors were tested by Licensee and found to be in operable condition. The Fire Extinguisher (2A40BC) is located in the kitchen and was last serviced on 9/26/2023. Electrical outlets were inaccessible. No recalled and or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary.

Bathroom: Children use the restroom located on the right of the home. LPA observed toilet and faucet to be clean and operable. No hazardous materials or items were observed in bathroom #1. LPA reminded applicant the children's bathroom must be free of accessible shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
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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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: ESPINOSA FAMILY CHILD CARE	FACILITY NUMBER: 197412963
	VISIT DATE: 10/13/2023

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Kitchen: Sharp utensils are stored in an upper kitchen cabinet. The kitchen is off limits to children in care. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, dinner and snacks are provided. Licensee stated she is participant in a food program.

Outdoor: Children play in the back yard. LPA toured the back yard and observed it to be free of garden tools, poisonous plants, thorn trees, cactus, or lawn mower inaccessible to children. The play area is clear and clean of debris, play area is fenced and gated all around. LPA observed age-appropriate play equipment for children.

Pools/Spas/Bodies of Water: LPA observed no bodies of water on the premises.

Advisory/Other: First Aid kit was observed in the kitchen pantry with supplies readily available. Licensee's CPR expires on 8/12/2025. Licensee's Mandated Reporter Training expires on 6/92024. LPA reminded licensee mandated reporter training and CPR must be completed every 2 years. Staff CPR/First Aid and Mandated Reporter Training is maintained current. LPA obsrved cleaning compounds stored in the laundry room on and upper shelf and inaccessible to children in care.

Licensee’s annual fees are current. LPA observed all required facility postings on premises. Licensee had the following required posted documents: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203) and Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148) and Fire/Disaster Log.

Documents Provided and or Discussed: Fire Drill Log, required postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227).

Licensee 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.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
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

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ESPINOSA FAMILY CHILD CARE	FACILITY NUMBER: 197412963
	VISIT DATE: 10/13/2023

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Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov. 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep. More information on Infant Safe Sleep procedures can be found online on the CDSS web page at https://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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
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

LIC809 (FAS) - (06/04)

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