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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414722
Report Date: 10/24/2025
Date Signed: 10/24/2025 04:03:27 PM

Document Has Been Signed on 10/24/2025 04:03 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
197414722
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 365-2879
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/24/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:52 PM
MET WITH:Juana Rodriguez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 10/24/2025 Licensing Program Analyst (LPA) Evelyn Garcia met with Licensee, Juana Rodriguez, who guided LPA 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. Upon arrival LPA observed 2 children in care. Family members residing in the home include 2 adults (licensee, and licensee's adult son). Facility operation is Monday-Friday for less than 24 hours a day. Overnight care is provided. Incidental Medical Services (IMS) policy was discussed. There is no pool/spa or body of water on the premises.

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). Off limit areas include all bedrooms (except bedroom #1), bathroom #2, kitchen/laundry area and the 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. Tables and chairs in the living room area meet the children's needs. LPA observed a fire extinguisher (2A10BC) however licensee stated she lost the receipt but purchased it in June of 2024. Licensee will purchase a new Fire Extinguisher and will submit purchase receipt to LPA. Smoke detector and carbon monoxide detector are in operable condition, located in the living room and nursery room. 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.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Evelyn Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414722
VISIT DATE: 10/24/2025
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 There is a designated area for ill children as necessary in the living room area. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current; there is working telephone (landline and cell).

Fire/earthquake drills are maintained current. Last fire/duster drill was completed on 9/25/25. Roster complete and maintained current. Health and Safety dated 8/18/18. Licensee showed proof of home ownership with mortgage statement.

Bathroom: LPA observed hazardous items such as shampoos, conditioners and mouth wash. LPA informed licensee that those items have to be removed and placed in a area inaccessible to the children. 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) with cots.

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. Left side of the front yard is on-limits and is shaded. There are pets on the premises. The backyard is off-limits. LPA observed a gate barricading the backyard. The BBQ was observed to be in the backyard area, not accessible to children.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid was observed to be invalid from National CPR Foundation and is not EMSA approved. Licensee will be cited a Type B violation and show proof of completion to LPA. Mandated Reporter was observed to be dated 7/9/24. There are no window cords accessible to children.

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.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Evelyn Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414722
VISIT DATE: 10/24/2025
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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.

Deficiencies: 1) Licensee will submit EMSA approved CPR certification to LPA 2) Licensee will purchase new fire extinguisher and show purchase receipt to LPA. 3) Licensee will update LIC 627 – Consent for Emergency Medical Treatment.

Exit interview conducted and report was reviewed with the licensee Juana Rodriguez. A notice of site visit was given to licensee and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Evelyn Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC809 (FAS) - (06/04)
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