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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700076
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:38:49 PM

Document Has Been Signed on 11/16/2023 01:38 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:SERRANO FAMILY CHILD CAREFACILITY NUMBER:
197700076
ADMINISTRATOR:SERRANO, TOMASAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 809-6722
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/16/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tomasa SerranoTIME COMPLETED:
01:45 PM
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On 11/16/2023 Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced annual random inspection. The LPA met with licensee who guided the LPA on a tour of the facility. Upon entry the LPA observed five children in care and two staff providing care and supervision.

This is a single-story family home with 3 bedrooms, ADU with permit and attached to the home, 4 restrooms and a pool in the back yard (pool gate is gated all around, is a least 5 feet(black mesh), gate swings away from pool, self close and has a self latching device. Main care is provided in the ADU referred to as the children's day care area. The children utilize the bathroom located in the day care area. The off-limits areas are the 3 bedrooms, three restrooms, side yard and the back yard with pool (there are three doors as exist. One door is separating the home entrance and is maintained key locked), the other is leading to the side yard( safety lock observed at the top of the door and door is also maintained locked,

The day care home provides breakfast, lunch, and afternoon snack. The operating child care hours are Monday through Friday from 6:30 a.m. to 5:30 p.m.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/16/2023 01:38 PM - It Cannot Be Edited


Created By: Isabel Ortega On 11/16/2023 at 11:49 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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observationm interview and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will begin to complete the indiviual infant sleeping plan LIC 9227 and submit a copy to the Pamdale Regional office by due date by email, via mail or text,
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will begin to complete the 15 minute check, log in time and submit a copy to the Pamdale Regional office by due date by email, via mail or text,
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:Isabel Ortega
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 11/16/2023
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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The knives are kept in the kitchen area on the top shelf Inaccessible to children. All cleaning chemicals and medication are stored inaccessible to children in care (LPA observed a child safety magnetic lock under the kitchen sink).

The First Aid kit was observed and complete. The required fire extinguisher (2A10BC) is in reading in green. Smoke and carbon monoxide detector(dual) is in operable condition (tested 10:30 a.m.). Fire and disaster drills are conducted every six months last drill was conducted 10/03/2023 at 10:00 a.m. Pediatric CPR and First Aid certificate is valid and does not expire until 5/10/2025. Licensee provided Mandated Reporter training certificate(AB1207) dated 11/04/2023.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148)


The LPA observed a current child roster. Child files were found to be complete.

There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 11/16/2023
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The licensee provided proof of immunization against pertussis (TDAP), measles (MMR), and influenza. The front yard is gated all around. The outdoor play area is free from debris. The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 11/16/2023
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Safe Sleep regulations (infants 0- 24 months) were discussed, two type Bs citations are being issued today. Licensee was not able to provide safe sleep logs for infants 0 to 2 years of age and Infant sleep plan for infants under one year of age. A plan of correction was completed. Licensee referred to the CCL web site for additional information and PINS. LPA provided infant Care plan form LIC9227 and went over 15-minute check logs, infant safe sleep plan and safe sleep PIN.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

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. 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
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700076
VISIT DATE: 11/16/2023
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Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was not found in compliance per Title 22 regulations, two deficiencies will be cited today. Technical advisories were provided as a preventative. An exit interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee. Appeal rights were provided and discussed with licensee.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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