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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700008
Report Date: 04/04/2023
Date Signed: 04/04/2023 11:00:34 AM

Document Has Been Signed on 04/04/2023 11:00 AM - 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:KAYLOR FAMILY CHILD CAREFACILITY NUMBER:
197700008
ADMINISTRATOR:JENNIFER KAYLORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 964-7127
CITY:VALENICASTATE: CAZIP CODE:
91354
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee Kaylor JenniferTIME COMPLETED:
11:20 AM
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On 04/04/23 Licensing Program Analyst (LPA) Andrew Alemoh, met with licensee, Kaylor Jennifer and her (helper/daughter #1) who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story 5 bedroom, 3 bathroom home with kitchen, dining room, family room, and a garage. There is no pool on the premises. Upon arrival LPA observed 6 children in care (4 infants) and 2 adults caring for them (licensee and licensee daughter). Family members residing in the home include 2 adults (licensee, licensee's daughter and minor daughter). Facility hours of operation are Monday - Friday 7AM- 5 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the playroom. Naps are provided on mats/cribs in the family room. Children drop off backpacks in the dinning room area. The children use the bathroom located in the hallway; second door on the left. The off-limits areas are all upstairs(barricaded by a baby gate), all bedrooms, and two bathrooms. Laundry room and garage are also off limits and are kept locked during business hours. 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 storage closet in the hallway, medicines are kept in licensee's bedroom and hazardous items (sharp knives are kept in the kitchen in the upper cabinet high enough that they are inaccessible to children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 04/04/2023
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Safe and age appropriate toys, play equipment and materials were observed. 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 family room. Per Licensee, no one smokes in the home, and 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 04/04/23.

Bathroom: There is no shower in the bathroom. Toilet and faucet are clean and operable. LPA did not observe any shampoos or shower gels in the children's bathroom.

Kitchen:(There is second baby gate barricaded the kitchen if need be). Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the storage closet and or laundry room which is locked during business hours. Sharp knives are located in the top kitchen cabinet making it inaccessible to children. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently does have a food program.

Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall and an iron fence. There is a friendly cat on the premises that does come in contact with children. LPA observed age appropriate toys, well secured and safe for children. The AC unit is made inaccessible to children by a baby gate barricading all around the AC unit.

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

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 04/04/2023
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There are no bodies of water in the premises.

Advisory/Other: First Aid kit was observed with supplies readily available located in the storage closet. CPR/First Aid has expired. Mandated Reporter has expired. LPA reminded licensee; mandated reporter/cpr training must be completed every 2 years. The fireplace is located in the family room which is screened.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee was unaware of the Infant Safe Sleep Pin. LPA provided licensee copies of the Infant Sleep Log, Individual Sleep Plan and Safe Sleep Chart. Licensee currently does have child care insurance.

Licensee Jennifer 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 Jennifer 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. 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.

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

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 04/04/2023
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The facility was cited type B deficiencies according to the California Code Title 22 Regulations (cite regulation).

See 809D for deficiency.

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: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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Document Has Been Signed on 04/04/2023 11:00 AM - It Cannot Be Edited


Created By: Andrew Alemoh On 04/04/2023 at 10:23 AM
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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee and helper #1 files and records review, the licensee did not comply with the section cited above in not having CPR/First aid certification which poses/posed a potential health, safety or personal rights risk to persons in care
POC Due Date: 04/21/2023
Plan of Correction
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Licensee shall complete the CPR/First aid training and send proof of completion to LPA before the due date .
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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


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