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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415105
Report Date: 02/07/2024
Date Signed: 02/07/2024 12:26:29 PM

Document Has Been Signed on 02/07/2024 12:26 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:KUMARAPERU FAMILY CHILD CAREFACILITY NUMBER:
197415105
ADMINISTRATOR:KUMARAPERU, YAMUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 296-6987
CITY:SAUGUSSTATE: CAZIP CODE:
91390
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee KumTIME COMPLETED:
01:00 PM
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On 02/07/2024 Licensing Program Analyst (LPA) Alemoh, met with licensee, Kumaraperu Yamuna who guided analyst on a tour of the facility for the One Year Required inspection. This is a town home w/ 2 bedrooms and 2 bathrooms. Upon arrival LPA observed 4 children in care and 1 adult caring for them. Resident residing in the home include 2 adults (licensee, and a tenant). Facility hours of operation are Monday - Friday 6:30AM- 6:30 PM. Upon parents request the facility is open on Weekends. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the playroom area. There are cameras inside the day care home. Safe and age appropriate toys, play equipment and materials were observed. A changing table was observed to be clean and orderly. Extra diapers and cleaning wipes were observed by the changing table. An infant room was observed with 3 cribs. A storage closet was observed to be locked containing licensee extra clothes.

The children use the bathroom located in the hallway to the left. The off-limits areas are all one bedroom, second restroom and the kitchen. Laundry room and garage are also off limits and are kept locked during business hours.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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: KUMARAPERU FAMILY CHILD CARE
FACILITY NUMBER: 197415105
VISIT DATE: 02/07/2024
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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 which are kept in the garage, no medicines for children however licensee medications are stored in the kitchen cabinet. (Sharp knives are kept in the kitchen in the cabinet that they are inaccessible to children).

The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No 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 the infant room. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 12/12/2023

Bathroom: LPA observed the toilet and faucet are clean and operable. Underneath the bathroom sink the cabinets are locked with safety latches. Shower/tub area was free of prohibited items.

Kitchen: Off-limits and barricaded by a safety gate. Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Children bring their own sippy cups to the day care home. Cleaning supplies are in the garage which is locked during business hours. Breakfast, lunch, AM/PM snacks and dinner are provided. Licensee stated she currently does not have a food program. Naps are provided on mats/cribs in the playroom area and infant room.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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: KUMARAPERU FAMILY CHILD CARE
FACILITY NUMBER: 197415105
VISIT DATE: 02/07/2024
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Outdoor: The front yard is off limits. The backyard is temporarily off-limits due to the recent rain storms and the weather. The backyard is completely fenced in with a brick wall. There are no pets on the premises. LPA observed age appropriate toys, well secured and safe for children. AC unit was observed to barricaded and made inaccessible to children.

There are no bodies of water in the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 02/25. Mandated Reporter expires on 01/08/2025. LPA reminded licensee; mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have child care insurance

Licensee Yamuna 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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: KUMARAPERU FAMILY CHILD CARE
FACILITY NUMBER: 197415105
VISIT DATE: 02/07/2024
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LPA discussed the safe sleep regulations with licensee Yamuna and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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. LPA provided licensee a copy of the safe sleep chart.

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: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC809 (FAS) - (06/04)
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