<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700475
Report Date: 03/22/2021
Date Signed: 03/22/2021 03:21:03 PM

Document Has Been Signed on 03/22/2021 03:21 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:SERRANO FAMILY CHILD CAREFACILITY NUMBER:
197700475
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
03/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Edna SerranoTIME COMPLETED:
03:21 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Thompson-Miller conducted a Tele-Visit with Applicant Edna Serrano, who guided analyst on a tour of the facility for a Prelicensing Inspection. COVID-19 Emergency Response Tele-Inspection call was conducted. This is a single story 4 bedroom, 2 bathroom home with kitchen/dining, living room, family room and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include one adult, (Applicant) and two children. Days/hours of operation will be Monday through Saturday from 4:00AM to 3:00AM (will vary based upon parent schedule). Incidental Medical Services (IMS) policy was discussed.

Physical Plant: The home is clean and orderly. The home entrance is through the front door. Main day care will be provided in the living room (at entrance). Bedroom #1 will be used for Foster Children and is off limits to child care. Bedroom #2 and #3 are off limits (safety knob). Bathroom #1 next to living room will be used by the child care. Bathroom #2 (master bedroom) off limits as well as the kitchen (safety gate) and garage. Children do not have access to the family room (off limits - adjacent to the kitchen). There is a designated area for ill children as necessary in the family room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. There are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (land line and cell). All poisons, medication (upper kitchen cabinet with safety latch) and cleaning items are inaccessible to children. Children nap on mats.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
VISIT DATE: 03/22/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean an operable and home has a refrigerator/freezer clean. Cleaning supplies are located in the storage. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, snacks and dinner will be provided.

Outdoor: The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises. There is a large Trampoline that is for Applicant children only (Declaration or written statement to be provided). Applicant written statement will include supervision of the children while in the yard and that no child care children will be allowed to engage in play on the trampoline. There is a separate gated grassy area (at this time it will be off limits due to the Trampoline to be moved to this area). There is a storage shed inaccessible to children on the grassy area.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 04/19/2021, Preventative Health and Safety including Nutrition and Lead Poisoning Prevention completed 1/9/2021. Orientation completed 12/03/2020.

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: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
VISIT DATE: 03/22/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Documents Provided and or Discussed: LPA will mail the following: COVID-19 posters, LIC311D, Lead Flyer, Safe Sleep, Seat Belt Safety

Before licensure the following must be completed:
1. Mandated Reporter (mandatedreporterca.com)
2. Declaration (Applicant will not be utilizing the grassy section of the backyard, trampoline for child care, also statement regarding Supervision)
3. Side gate (wrought iron) need to be locked
4. Child care area (living room) window cords to be inaccessible to children
5. Bedroom #4 (blue room) cable socket to be inaccessible to children
7. Smoke detector in Bedroom #4 to be placed higher on the wall (inaccessible).

Once corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn.

All adults living/residing in the home are fingerprint cleared and associated.
Licensee approved for large capacity license.
Exit interview conducted and a copy of this report will be emailed to Applicant (due to COVID-19). The read receipt is in lieu of a signature.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3