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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700008
Report Date: 09/23/2025
Date Signed: 09/23/2025 03:35:28 PM

Document Has Been Signed on 09/23/2025 03:35 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:KAYLOR FAMILY CHILD CAREFACILITY NUMBER:
197700008
ADMINISTRATOR/
DIRECTOR:		JENNIFER KAYLORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 964-7127
CITY:VALENICASTATE: CAZIP CODE:
91354
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/23/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Jennifer KaylorTIME VISIT/
INSPECTION COMPLETED:
03:36 PM
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On September 23, 2025, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility. LPA met with Licensee, who granted access. LPA and Licensee toured the home inside and outside for an Annual Random inspection. Residing in the home are the Licensee, one adult and no minor children. The home is licensed for twelve to fourteen children. LPA observed seven napping day care children ages 2-4 years old with licensee during inspection. Daycare hours are 7:00 AM-5:30 PM. Monday through Friday. All adults residing or working in the facility did not have Criminal Record Clearance (DOJ/FBI) and Child Abuse Central Index Clearance and are not associated to the facility license. One adult living in the home did not have Criminal Record Clearance. Licensee stated they thought the background check was completed.
Physical Plant: This is a two story five-bedroom, three-bathroom home with kitchen, dining room, family room, living room, laundry room, and garage. Childcare is provided: in the living room upon entry. Children’s Bathroom: is in the hallway on the left. It was observed to be clean, with soap, toilet paper, functioning sink and toilet. The cabinets were locked with a safety latch and there was cold medicine accessible in the medicine cabinet on the higher shelf. License stated it was an honest mistake and removed it. The unused outlets in the home were covered. The blind cords are tied up high. LPA observed toys, books, and furniture that were the appropriate height. There were mats for napping equipment. The home was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, hazardous conditions. The cleaning supplies are kept inside the laundry room locked. The medicines are kept in the hallway closet. The windows are screened, free of bugs, cracks, and debris. The fireplace is inside the family room observed screened with a glass covering. The home has central air conditioning and heat.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2025
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.

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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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 09/23/2025
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There was not a designated parent wall. Licensee stated the hallway closet is used for parent documented information and where they access their diaper bags, shoes, etc. There is no landline phone, but cell phone. The stairs were not gated. There was a separate gate blocking the day care area from the rest of the home. The temperature inside the home was comfortable.The fire drill was conducted: on 8/2/25. The earthquake drill was not conducted. Licensee conducted emergency drills using the fire alarm. The child and parent roster was not current and not complete with all required information. Licensee stated that they have not updated the roster. The fire extinguisher (2A:10BC) was full, and needle was inside the green area kept underneath the sink with a safety latch. The smoke alarm and carbon monoxide detector were tested and are operable. An audible device was observed. There was a single action door handle.

Kitchen: There was a gate in front of the kitchen. Inside the Kitchen, the sharp knives were visible on the counter and the other sharp utensils were unlocked inside a drawer. Licensee stated meals and snacks are provided and there are known allergies. The refrigerator and freezer were both working.


Off limit areas: Garage, kitchen, all bedrooms and other bathrooms in the home, laundry room, and dining room.
Outside: The backyard is completely fenced and locked. The fencing material was wrought iron and concrete block and in good condition. Licensee stated, there are pets in the home a turtle, two small dogs, and one cat. Licensee stated the pets are vaccinated and do not interact with the day care children. Licensee stated there are no bodies of water on premises. LPA did not observe any. There is a shaded rest area with tables and chairs. The air conditioning (AC) unit in the yard was observed gated. Licensee stated the neighboring home on the right has an in-ground swimming pool as a body of water. The fencing in between the homes is block concrete observed sturdy and at least 5 ft. high. There was grass, sand, and concrete for active play, bikes, play equipment, plastic play structure with one slide and sand as cushioned surface, and a play house all aged appropriately.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 09/23/2025
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Other Review: Licensee stated, there are no weapons or firearms on the premises. LPA did not observe any. The mandated reporter training was not viewed. CPR/First Aid (Exp: 4/2025), and immunizations were not available. There is a First Aid kit inside the home. LPA viewed staff and children’s files. Licensee stated transportation is not provided. Incidental Medical Services (IMS) policy and Safe Sleep regulations were discussed. Licensee stated, the home does daycare liability insurance. LPA conducted a staff interview with the Licensee. LPA reviewed LIC 126 with the Licensee. LPA discussed Child Care Advocate information with Licensee.
The following was discussed with the Licensee:
Maintain capacity and transparency per posted parent rights, Roster requirements (keep updated information always and maintain information for three years), Documentation for disaster drills (fire and earthquake drill are conducted every six months). Maintain mandatory forms, signed, for the children’s/staff files, know the updated Safe Sleep regulations. The role and responsibilities of being a mandated reporter. Supervision is required for children in care. If food is brought in, it is properly labeled. Check food expiration periodically. Licensee is responsible for knowing the regulations as well as anyone who assists in providing care. Temporary absences shall not exceed 20 percent of the hours that the facility provides care per day. If day care is inactive for an extended period, you may notify Licensing. Inaccessibility of hazards must be constantly reassessed depending on the children in care. If the phone number is changed, or someone moves in or out of the home, licensing must be notified.

Regulations prohibit the smoking of tobacco in a private residence that is licensed as a family childcare home and areas of the day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy rocker seats, exer saucers, bassinettes, and any other items that fall into that category. Safe Sleep regulations: require infants sleeping on their back unless specified with LIC 9227 form, no blankets, toys, or pacifiers attached to their clothing and Licensee will observe infants every fifteen (15) minutes and maintain a napping log.

The Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 09/23/2025
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to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.Type A deficiency: Type A deficiency shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is an immediate risk to the health, safety, or personal rights of children in care. Licensee shall provide a copy of any Type A deficiency to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of the Type A report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) must be placed in each of the children’s files for verification of the Type A deficiency. Failure to do so will result in a civil penalty being assessed.
=Licensee is advised to visit: www.shotsforschool.org for Immunization information.
=Licensee was informed of their responsibility to report suspected Child Abuse (LIC 9108), 1-800-827-8724/760-243-6640. Licensee was informed of the MyChildCarePlan.org website, a
consumer education website that helps families obtain childcare by connecting them to child
care providers and Resource and Referral Agencies (R&Rs) throughout California.
=Family Child Care Providers (Disaster Planning information):
https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/
=Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
=Child Care Videos: https://ccld.childcarevideos.org
=Licensee advised to visit the CCLD website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
=Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department prior to providing the IMS. The following information regarding ADA was provided: US Department of Justice (USDOJ)
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 09/23/2025
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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.
=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-andresources/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. =To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
=Lead Poisoning: For more information, view PUB 515 and go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

Reminder: The CCLD On Duty Worker is available: Monday through Friday from 8:00 AM - 5:00 PM, at (661) 202-3318 for questions, information, and Unusual Incident Reporting. Once the incident is reported within twenty-four (24) hours via telephone, follow up with a written report via email to: unusualincidentreport@dss.ca.gov or via fax to: (661) 202-3810 within seven days of reporting.

There are deficiencies cited during this inspection. See LIC 809D pages attached to this report. There is a Type A deficiency cited during this inspection for Criminal Record Clearance with an immediate civil penalty for $500 per person. See LIC 421BG page attached to this report. There are Technical Violations issued. See LIC 9102 TV pages attached to this report.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008
VISIT DATE: 09/23/2025
NARRATIVE
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Upon receipt of a Type A deficiency, a copy of the licensing report must also be posted for thirty (30) days. The report must be provided to parents/guardian of children enrolled currently and any newly enrolled at the facility during the next twelve (12) months. Licensee must obtain a signed Acknowledgment of Licensing Report form (LIC 9224) from each parent/guardian and place it inside each child's file (for three years) at the facility. Copies of the reports must be provided to each parent when a Type A violation is cited along with the LIC 9224 form. If these requirements are not met, civil penalties per family will be assessed.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit, and Appeal Rights were provided to Jennifer Kaylor, Licensee during the inspection. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain the posting will result in $100 civil penalty.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 09/23/2025 03:35 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/23/2025 at 03:11 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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
102370- Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:

(1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, iinterview,and record review, the licensee did not comply with the section cited above in their adult child living in the home did not have a Criminal Record Clearance and was not associated to the facility and was observed providing care to the children during the inspetion which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2025
Plan of Correction
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2
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I will provide proof as soon possible to Licensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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2
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


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Created By: Kuliema Calloway On 09/23/2025 at 03:17 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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

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
1
2
3
4
Based on observation, interview, and record review the licensee did not comply with the section cited above in their mandated reporter training was expired during inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2025
Plan of Correction
1
2
3
4
I will provide proof by POC date
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, and record review the licensee did not comply with the section cited above in their immunization records were not available during the inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2025
Plan of Correction
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2
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4
I will provide proof by POC date of immunizations.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2025 03:35 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/23/2025 at 03:17 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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation interview, and record review the licensee did not comply with the section cited above in C2, C3, C4, and C5 did not have immunization records in their files during inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2025
Plan of Correction
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2
3
4
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in C1- C5 were missing from the roster and the roster was not updated which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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2
3
4
I will provide an updated roster by POC 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.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


LIC809 (FAS) - (06/04)
Page: 10 of 13
Document Has Been Signed on 09/23/2025 03:35 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/23/2025 at 03:17 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: KAYLOR FAMILY CHILD CARE
FACILITY NUMBER: 197700008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in C4 and C5 did not have LIC 995 in files during inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
1
2
3
4
I will have the parents sign the form and place it in the childrens files.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


LIC809 (FAS) - (06/04)
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