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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414722
Report Date: 07/07/2023
Date Signed: 07/07/2023 12:43:45 PM

Document Has Been Signed on 07/07/2023 12:43 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
197414722
ADMINISTRATOR:RODRIGUEZ, JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 365-2879
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Juana Rodriguez,LicenseeTIME COMPLETED:
01:20 PM
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On 07/07/2023 Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee, Juana Rodriguez, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 3 bedroom, 2 bathroom home with kitchen/dining, family room, living room, laundry room, and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 4 preschool age child in care. Family members residing in the home include 3 adults (licensee, licensee's daughter, and licensee's son) and one minor child. Facility operation is Monday-Friday for less than 24 hours a day. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the left. Children have access to the living room and bedroom #1 (nursery room). Per licensee, infants have been staying in the living room due to she only has one infant enrolled at this time. Off limit areas include all bedrooms (except bedroom #1), bathroom #2, kitchen/laundry area and garage (has a key lock door knob). The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in master bedroom with self-latch lock and key lock), medicines (in upper kitchen cabinet) and hazardous items (sharp knives in kitchen drawer with safety latch) that can pose a danger to children. LPA did not observe a fireplace in the home. Safe and age appropriate toys, play equipment and materials were observed. LPA observed a fire extinguisher (2A10BC), smoke detector and carbon monoxide detector are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the nursery room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (landline and cell).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414722
VISIT DATE: 07/07/2023
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Fire/earthquake drills are maintained current. Last fire/duster drill was completed on 05/23/2023. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in master bedroom(off limit with key lock and latch lock). Breakfast, lunch, snacks and dinner are provided. Licensee currently has a food program. Naps are provided in the main care area (living room)

Outdoor: The front yard is safe for children. LPA observed the front yard to be fully barricaded by wrought iron fence/cement and observed age appropriate play equipment. There is one dog on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 05/17/2025. Mandated Reporter expires 07/08/2024. There are no window cords accessible to children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414722
VISIT DATE: 07/07/2023
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Documents Provided and or Discussed: Safe Sleep Chart (Every 15 minute Check), Individual Sleeping Plan (LIC9227), and Safe Sleep PIN 20-24-CCP. Licensee stated currently does not have child care insurance.

Licensee Rodriguez 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.

LPA discussed the safe sleep regulations with licensee Rodriguez 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 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.

No deficiencies have been cited at this time.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Juana Rodriguez along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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