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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419791
Report Date: 08/10/2023
Date Signed: 08/10/2023 04:34:30 PM

Document Has Been Signed on 08/10/2023 04:34 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GIANI FAMILY CHILD CAREFACILITY NUMBER:
197419791
ADMINISTRATOR:GIANI, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 364-2228
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Adriana Giani, LicenseeTIME COMPLETED:
04:54 PM
NARRATIVE
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On Thursday, August 10, 2023, at 12:40 p.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with licensee Adriana Giani who guided LPA Rivera on a tour of the facility.

During this inspection, 9 children (3 infants and 6 school age) were present. Family members residing in the home was discussed with licensees and are background cleared. Operating hours are Monday to Friday, 7:00 a.m. to 5:30 p.m., and care for children ages 0 to 12 years.

All areas identified on the facility sketch were inspected by LPA Rivera. This is a single home which consists of three bedrooms, three bathrooms, kitchen, living room, den (daycare room) garage, and front and backyard. Areas that are accessible to children and identified on the facility sketch include: den (daycare room) and bathroom located in the daycare room. Areas off limits to children include: three bedrooms and 2 bathrooms, kitchen and garage. LPA observed the bedroom doors to be closed. LPA did not observe any barriers to prevent children entering the kitchen area. Per licensee, the gate barriers were removed.

At approximately 12:42 p.m., LPA observed license, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch and license posted near the main entrance area. LPA also reviewed Child Care Facility Roster and observed the roster to be incomplete. LPA reminded licensee the roster must be completed and updated when there is a new enrollment and disenrollment.

At approximately 12:53 LPA Rivera, inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and land line). For ventilation, LPA observed central AC/heater and vents located on the ceiling. LPA Rivera observed the furniture, children’s materials, and sleeping mats to be age appropriate and in good condition. LPA observed 3 cribs and 2 cribs were occupied by sleeping infants. At 12:55 p.m., LPA observed child #1 and #2 sleeping with the attached string pacifier. LPA informed licensee
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 11
Document Has Been Signed on 08/10/2023 04:34 PM - It Cannot Be Edited


Created By: Mayra Rivera On 08/10/2023 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)(1)(A)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Rivera observation, the licensee did not comply with the section cited above in not removed the attached pacifiers on the 2 infants while sleeping which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2023
Plan of Correction
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At 12:56 pm, Licensee Adriana removed the attached pacifiers and removed them from the crib.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Mayra Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/10/2023 04:34 PM - It Cannot Be Edited


Created By: Mayra Rivera On 08/10/2023 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Rivera observation,, the licensee did not comply with the section cited above in not having the 2A10BC fire extinguisher serviced annually or purchasede within the year which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2023
Plan of Correction
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LIcensee Adriana stated she will call the fire extinguisher service company to come and service the extinguisher.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above in not conducting a disaster drill within the last 6 months (last drill 1/5/2022) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2023
Plan of Correction
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Licensee Adriana stated she will be conducting a disaster drill within the 30 days and before due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Mayra Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


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Document Has Been Signed on 08/10/2023 04:34 PM - It Cannot Be Edited


Created By: Mayra Rivera On 08/10/2023 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in not completing the Mandated Reporter training and does not remember the last time she completed the trainihng which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2023
Plan of Correction
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Licensee Adriana stated she will complete the AB 1207 Mandated Reporter Training by due date September 8, 2023.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in not having staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2023
Plan of Correction
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Licensee Adriana stated, she is going to ask her assistant in where she placed the files and will provide LPA Rivera copies of the staff files by due date 9/8/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Mayra Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791
VISIT DATE: 08/10/2023
NARRATIVE
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infants cannot be sleeping with the attach string pacifier as it is a strangulation hazard. Licensee immediately removed the pacifiers from the sleeping infants. LPA also observed a pillow in infant #1 crib. LPA informed safe sleep regulation states no pillows inside the infant cribs. Licensee removed the pillow from the crib.

At approximately 1:03 p.m., LPA observed cleaning compounds items stored inside the laundry room located at the end of the kitchen and observed the door closed. LPA advised to place a barrier to make it inaccessible for school age children to open the door. Knives and sharp objects are stored on top of the refrigerator. LPA observed filtered water. Licensee provides the meals and LPA informed if food is brought from children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. During this visit licensee stated currently has no children with food allergies or prescribed or non-prescribed medication. For ill isolation area, the living room is utilized.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has two dogs and two cats, no poisons, no bodies of water no firearms, or weapons. LPA did not observe, firearms, weapons nor bodies of water. LPA observed two dogs (mixed dog and Pitbull), and the wading pool with no water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 1:13 p.m, LPA Rivera entered the bathroom and observed the toilet, running water, hand soap and paper towels. Inside the bottom cabinet, LPA did not observe items that can pose a potential hazard to children and observed the cabinet with a childproof lock. LPA observed a bucket of water inside the bathtub. Licensee stated she was using the water to flush the toilet. Licensee Adriana empty the bucket of water.

At approximately 1:25 p.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged. LPA did not observe a service tag nor a purchase receipt within the year. LPA informed the fire extinguisher must be serviced annually or purchase within the year and tape the receipt on the extinguisher. LPA observed carbon monoxide detector and the smoke detector located in the daycare room. LPA Rivera tested the carbon monoxide and the smoke detector. Carbon and smoke detectors are operable. LPA observed the first aid kit complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the daycare room. LPA observed the last earthquake/fire drill log conducted on 1/5/2022. LPA reminded licensee the drill must be conducted every 6

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791
VISIT DATE: 08/10/2023
NARRATIVE
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months and best practice once a month.

At approximately 1:29 p.m., LPA inspected the outdoor area (backyard) used by children for safety, comfort and cleanliness, LPA observed the patio to be fenced all around and the side gates opened because the technician from Frontier was present fixing the internet service. LPA did not observe any children playing outside. Licensee stated the side gates are closed when the children are present outside playing. LPA observed the play equipment to be age appropriate, in safe condition, free of sharp, no loose or pointed parts.



LPA observed licensee Adriana Giani Pediatric First Aid/ CPR certification dated 6/21/23. LPA was not able to review licensee’s Health and Safety certification, proof of immunization against Pertussis, MMR and Influenza. Licensee stated she has not completed the mandated reporter (AB 1207) certification. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA reviewed children’s files and observed the files to be incomplete. LPA was not able to review assistant file, because licensee was not able to find the file folder.

The following was also discussed with licensee:
1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification and a valid criminal record clearance associated to the facility license and immunizations, AB 1207 Child Abuse Mandated Reporter Certificate.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791
VISIT DATE: 08/10/2023
NARRATIVE
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6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

10. Children and staff records must be maintained and updated as needed and be available for review by the Department.



11. Dog(s) and/or pets are recommended to be isolated from children in care.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

16. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791
VISIT DATE: 08/10/2023
NARRATIVE
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Criminal Record Statement
Licensee Adriana Giani was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Safe Sleep


LPA discussed the safe sleep regulations with licensee Adriana Giani 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 Adriana Giani 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.

This facility provides Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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.

During this visit, one Type A violation, four Type B violations and 3 Technical Violations were given. LPA Rivera provided the LIC 9224 Acknowledgment of Receipt of Licensing Reports and informed licensee this form must be given to the parents and during enrollment for one year.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Adriana Giani.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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