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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492997
Report Date: 06/08/2022
Date Signed: 06/08/2022 02:54:18 PM

Document Has Been Signed on 06/08/2022 02:54 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:LEIVA FAMILY CHILD CAREFACILITY NUMBER:
197492997
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Isabel LeivaTIME COMPLETED:
03:09 PM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Isabel Leiva, 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 room, dining room area (in kitchen for children), family room, living room (converted daycare) and garage. There is no pool on the premises. Upon arrival LPA observed 3 children with the licensee.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway near the homes bedrooms. Children have access to the living room room, one bedroom (nap room), dining area in kitchen, children's bathroom and backyard. Off limit areas include 2 of the homes bedrooms, 1 bathroom, kitchen, family room, dining room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible in garage), medicines (inaccessible in top kitchen cabinet) and hazardous items (sharp knives inaccessible in top kitchen cabinet) that can pose a danger to childr. Per Licensee no one smokes in the home. Electrical outlets are inaccessible. There is a designated area for ill children as necessary in room. Per Licensee there are no weapon/firearms in the home. During the visit LPA Dorsey observed a baby rocker in the home. Per licensee she does not have infants at the moment but the rocker is used if an infant is enrolled. LPA Dorsey advised licensee that the item shall not be used in her child care home. LPA Dorsey observed the item was removed from the nap room and placed in the garage. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon detector, and Fire Extinguisher (2A10BC) are in operable condition
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 7
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: LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 197492997
VISIT DATE: 06/08/2022
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The last fire/earthquake drill was completed 05/24/21. LPA Dorsey advised licensee to conduct disaster drills every six months and document the time and date of these drills. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.

Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are stored in the garage. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has concrete for children to play. LPA observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expires 07/2023. Mandated Reporter was last completed 08/07/19. LPA advised licensee to retake the Mandated Reporter Training and retake the training every two years. Children nap on cots in the on limits bedroom if necessary. Per licensee at the time she does not have any children that nap.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
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: LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 197492997
VISIT DATE: 06/08/2022
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LPA discussed the safe sleep regulations with licensee 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.

A notice of site visit was given 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 Isabel Leiva.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
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