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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700515
Report Date: 01/25/2024
Date Signed: 01/25/2024 11:25:47 AM

Document Has Been Signed on 01/25/2024 11:25 AM - 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:FLORES FAMILY CHILD CAREFACILITY NUMBER:
197700515
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/25/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Ariacne FloresTIME COMPLETED:
11:30 AM
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On January 25, 2024, Licensing Program Analyst (LPA) Kris Diaz, conducted an unannounced Annual/Random inspection. LPA met with Licensee, Ariacne Flores who guided LPA on a tour of the home. Licensee is requesting a capacity increase. People who reside in the home are the Licensee and her spouse who are live scanned and have TB skin test on file, and their 2 minor children (7, 9). Upon arrival, LPA observed 8 children in care with licensee and assistant. The small family childcare home operates Monday – Friday 5:00am-7:00pm. Incidental Medical Services were discussed. Per licensee, there are no children in care that require IMS at this time.

This is a one story 3-bedroom, 2-bathroom home with kitchen, dining room, family room, laundry room, and attached garage. There is no pool/or body of water on the premises. The children have access to the childcare room, the living room, dining room, restroom near the childcare room, and the backyard. The off-limits area includes the other 2 bedrooms, kitchen, garage, and side yards. The areas are made inaccessible with retractable gates and safety knobs. LPA observed licensee move shampoos and soaps from the shower and place in inaccessible cabinet under restroom sink. LPA also observed licensee move personal cosmetic products from restroom mirror to cabinet under sink making them inaccessible. LPA observed several age-appropriate toys and activities in the childcare room and backyard. LPA reminded licensee that pack n play used as crib can only be used for sleeping infant. LPA advised licensee to use an enclosed mesh gate for infant when not sleeping. Per licensee, 100% supervision is provided to children in care at all times.

The home was inspected inside for comfort, cleanliness, telephone service, heating and ventilation. Medications are stored in an upper kitchen cabinet inaccessible to children. The kitchen knives are stored in kitchen cabinet inaccessible to children in care. Cleaning compounds are stored in the garage inaccessible to children.

The First Aid kit is located in the entry hallway inaccessible to children. Per licensee, there are no weapons or firearms in the home. LPA did not observe any weapons or firearms. Smoke detectors and carbon monoxide detectors are in operable condition.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 197700515
VISIT DATE: 01/25/2024
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The Fire Extinguisher (2A10BC) is fully charged and green and meets the standards of the State Fire Marshal. LPA advised licensee to get extinguisher checked as needle is close to edge of green. The licensee’s Pediatric CPR/First Aid expires 4/2025. The licensee and assistant have the required immunization against pertussis (TDAP) and measles (MMR). The licensee and assistants’ Mandated Reporter training expires 1/2025.

The required posted documents were posted and located on the parent’s board in the childcare room: Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), and LPA provided a copy of Earthquake Preparedness Checklist (LIC9148) and observed licensee post during inspection. LPA also provided licensee an updated PUB394 and observed licensee post.

The following was discussed with the licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; The licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

The licensee was informed that all adults living in or having access to the home, or are employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If this is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week. The licensee was advised to utilize the Request for Live scan Service LIC9163 to have adults fingerprinted and associated to the home.

The licensee was advised of the requirement 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 197700515
VISIT DATE: 01/25/2024
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The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, licensees, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensees 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.

Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

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

Lead Flyer Requirement Health and Safety Code 1596.7996 mandated that effective January 1, 2019,

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 197700515
VISIT DATE: 01/25/2024
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CCC's and FCCH's are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement.

The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

The home is ready for capacity increase. LPA will issue license and mail to Licensee by Monday, January 29, 2024.

This inspection visit was conducted in person. The report was read with the licensee and a copy of the report, notice of site visit, and appeal rights was provided to Licensee, Ariacne Flores. Exit interview was conducted.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC809 (FAS) - (06/04)
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