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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700475
Report Date: 02/27/2024
Date Signed: 02/27/2024 04:46:09 PM

Document Has Been Signed on 02/27/2024 04:46 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:
197700475
ADMINISTRATOR:SERRANO, EDNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 664-9798
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/27/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Licensee Edna SerranoTIME COMPLETED:
04:59 PM
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On 2/27/2024 at 1:37pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual random inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPA observe 9 children in care and two staff providing care and supervision (fingerprint cleared and associated to the center.)

The operational childcare hours are Monday through Sunday varied up to 23 hours depending on family's need.

This is a one-story family home. There is a living room, classroom, kitchen, three bedrooms, two bathrooms, laundry area, and attached garage but not accessible from inside the home via a safety gate and lock. Licensee does provide napping, there are 12 mats and 1 crib. The off-limits areas are the two bedrooms, second bathroom, living room, and garage. Licensee provides breakfast, lunch, and dinner for the children care. 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. Hanging window blind cords: The cords are inaccessible to children. Pets: there are no pets on premises; the Licensee recently had a pet dog but no longer has a pet in the home. There is a fireplace that is screened and off-limits to the children in care.. Phone service: There is a working cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does provide transportation for children; Licensee is aware that they must have a valid driver license, insurance, and vehicle registration at all times while transporting children in care. Isolation occurs in the far corner of the classroom for children in care showing signs of illness and also is used for calming.

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
VISIT DATE: 02/27/2024
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Knives are kept in the kitchen in a high cabinet, inaccessible to children in care. Medication is kept in the kitchen in a high cabinet, inaccessible to children in care. Cleaning supplies and chemicals are kept in the inaccessible under the sink, secured by a safety latch and the kitchen is gated, making it inaccessible to children in care.

There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons, firearms, and ammunition. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, adhesive tape, and cleansing pads/solution was observed to be complete and inaccessible to children kept high in the classroom area. The required fire extinguisher (2A10BC) is reading in green, (2/2023.) Smoke and carbon monoxide detectors were found to be in operable condition, tested at 2:27pm and 2:26pm, respectively. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 2/2/2024 at 9:00am.

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).

Licensee does not have insurance on the family child care home and has the parents complete the LIC 282-Affidavit Regarding Liability Insurance for Family Child Care Homes.

The Licensee did not have proof of immunization against pertussis (TDAP), measles (MMR), TB, and Influenza vaccination/statement declining the Influenza for self; however, the Licensee was provided technical assistance on the documents needed for herself in her own personnel file.



Licensee was not able to provide a valid CPR/First Aid training certification, this is a Type B violation, see the LIC 809D for the details. Child Care Provider Mandated Reporter Training Certificate has been completed on 1/19/2023 and valid until 1/2025. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Training, Immunizations: MMR, Tdap, TB, & Flu shots, and background clearances; the employee did not have a valid Pediatric First Aid & CPR.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
VISIT DATE: 02/27/2024
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Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, and LIC 9212-Family Child Care Consumer Awareness Information; however, the Licensee was not aware that the PM 286-California School Immunization Record had to be completed and there were no forms in any file, this is a Type B violation, see the LIC 809D for the details. Licensee was explained the policy and provided the form PM 286.

Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative 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 to initial presence in a licensed Family Child Care 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.

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 Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
VISIT DATE: 02/27/2024
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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed the Facility Representative 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. Provided Licensee with an Infant Sleep Plan form LIC 9227 and the sleep log.

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 PIN 22-02-


CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
VISIT DATE: 02/27/2024
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The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is not in compliance, three Type B Deficiencies have been cited. Please, see the LIC 809D for the citations.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Facility Representative.

All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/27/2024 04:46 PM - It Cannot Be Edited


Created By: Andrea Pittman On 02/27/2024 at 04:17 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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above by the Licensee not having a valid Pediatric CPR/First Aid certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee will text the proof of verification of the Pediatric CPR/First Aid certification no later than 3/12/2024.
Type B
Section Cited
CCR
102418(g)(1)
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. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having proof of the PM 286 for all children not enrolled in school which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee will text the proof of verification of the PM 286 no later than 3/12/2024.
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:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 02/27/2024 04:46 PM - It Cannot Be Edited


Created By: Andrea Pittman On 02/27/2024 at 04:17 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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(c)
Child's Records
(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having the school enrollment forms for the three school age children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee will text the proof of the school enrollment forms for the three school age children no later than 3/12/2024.
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:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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