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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700448
Report Date: 05/22/2024
Date Signed: 05/22/2024 03:40:03 PM

Document Has Been Signed on 05/22/2024 03:40 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:GOMEZ-CASTILLEJOS FAMILY CHILD CAREFACILITY NUMBER:
197700448
ADMINISTRATOR/
DIRECTOR:		MONICA GOMEZ-CASTILLEJOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 236-9978
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:18 AM
MET WITH:Monica Gomez-CastillejosTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On May 22, 2024, at 11:18 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Gomez-Castillejos Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee, Monica Gomez-Castillejos and stated the reason for the inspection. LPA was granted access to the facility. However, the licensee stated that she needs to pick up children and will be back by 1:00 P.M. LPA told the licensee if she could provide the children’s files, Facility Roster, and Fire/Earthquake drills before she leave the facility. Licensee provided the childrens files and the Fire/Earthquake Drills to LPA. LPA stayed in the car and conducted a records review of the documents provided while waiting for the licensee. Licensee left the facility at 11:41 A.M.

Upon arrival of the licensee at 1:35 P.M., the LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: living room (play area #1), family room (play area #2), bedroom #1, bathroom #1 (nap time room), and backyard (outdoor play area). Licensee states the day care hours of operation is Monday to Sunday, from 4:00 A.M. to 9:00 P.M. Currently living in the home is the licensee, and licensee’s fiancé. Licensee is currently providing transportation to children in care. Licensee has current California Driver’s License, vehicle registration, and car insurance. During this visit, LPA observed two children present in the facility with the licensee providing care and supervision. Licensee has no outstanding fees.

Physical Plant: 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 smoke detector and carbon monoxide device are in

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE
FACILITY NUMBER: 197700448
VISIT DATE: 05/22/2024
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operable conditions (tested at 1:59 P.M.). The facility has a fully charge fire extinguisher (2-A:10-B:C classification, reading in green, checked at 2:01 P.M.) and the last service date was on 02/14/2023. Licensee stated that she owns no firearms, and no one smokes in the facility. LPA observed cleaning products and detergents are stored under the kitchen sink and secured with a child safety lock. Knives are stored at the top shelf of the kitchen cabinets and are inaccessible to children.

Licensee stated that household medications are stored inside the closet in the licensee’s room and zero medications are currently being provided for the current children in care. Licensee stated that she is enrolled in a food program and is providing meals and snacks to children in care.

The facility is a one-story house. There is a metal fence that blocks the fireplace to make it inaccessible to children in care. The home has heating and air conditioning units.


Based on records review, licensee conducted the fire/earthquake drills on April 4, 2024, at 12:00 noon. Safe and age-appropriate toys for different ages, children’s books, puzzles, crayons, kitchen set toys, supermarket set toys, building blocks, cubbies, tables and chairs were observed during this visit.



LPA observed sleeping cots and folding mats in bedroom #1 (napping room). LPA also observed 2 cribs in bedroom #1. Per licensee, boys are separated from girls during napping. Licensee has first aid kit boxes stored inside the closet by the entrance door. LPA observed electrical outlets are covered with a child safety plastic cover to prevent access to children in care. Licensee also stated that she has two dogs which are inside a dog kennel and are inside the licensee’s room.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. LPA did not observed razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE
FACILITY NUMBER: 197700448
VISIT DATE: 05/22/2024
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Currently, the licensee has four children enrolled in the facility. Licensee stated that when a child shows signs of illness, the child is separated from other children in bedroom #1 and parents are called immediately to pick up their child.

Outdoor: The facility has no body of water on the premises. The outdoor play area has age-appropriate toys and play equipment. LPA observed toy house, swing set, two slides for little and big children. Per licensee, the outdoor play area is currently not being used by children in care.

At around 2:27 P.M., the licensee, together with the two children left the facility to pick up two other children. Licensee stated that she will be back at 3:00 P.M. Licensee allowed the LPA to stay in the facility while waiting for the licensee. The licensee arrived at 3:07 P.M. Per licensee, the two children that were present in the morning were pick up by the parent outside.

At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA reviewed four children’s files and licensee files. Based on records review, the children’s files are complete. Licensee has current CPR/First Aid training dated 01/06/2024. However, the Licensee has expired mandated reporter training. The licensee was advised to renew the online mandated reporter training at www.mandatedreporterca.com. Licensee has proof of immunization against Measles, Pertussis, and Influenza. Licensee has TB skin test on file.

Licensee has received criminal record clearance.

The following was discussed with the licensee:

The licensee was reminded that 100% supervision is always required for children in care. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE
FACILITY NUMBER: 197700448
VISIT DATE: 05/22/2024
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care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

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.



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.

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

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Our Quarterly updates come out every 3 months and are also in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE
FACILITY NUMBER: 197700448
VISIT DATE: 05/22/2024
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The Licensee is informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM to 5:00 PM.

The facility is not in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo observed a deficiency that may hinder the health and safety of the children in care. A Type B deficiency was cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.



During the exit interview the licensee Monica Gomez-Castillejos confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Notice of Site Visit: A Notice of Site Visit (LIC 9213 was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A copy of this Report was reviewed, and Appeal Rights were also provided to Licensee, Monica Gomez-Castillejos.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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Document Has Been Signed on 05/22/2024 03:40 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 05/22/2024 at 03:18 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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE
FACILITY NUMBER: 197700448

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2024

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 record review, the facility did not comply with the section cited above by failing to provide the licensee’s mandated reporter training which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Licensee will email a copy of her mandated reporter training certificate to LPA.
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:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024


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