197700913-2-20-2025-12-CC-JDMO-DE3TDC-20250220133807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700913
Report Date: 02/20/2025
Date Signed: 02/20/2025 01:39:07 PM

Document Has Been Signed on 02/20/2025 01:39 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 CARE		FACILITY NUMBER:	197700913
ADMINISTRATOR/ DIRECTOR:	MONICA GOMEZ-CASTILLEJOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 236-9978
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	02/20/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Monica Gomez-Castillejos		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

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On February 20, 2025, at 9:00 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo, conducted a Pre-Licensing inspection with applicant, Monica Gomez-Castillejos to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee recently relocated and is requesting to provide care for a Large family childcare home for the capacity of 14 children at this new location. Currently living in the home are the applicant and one adult (Applicant’s fiancé). LPA toured the home indoor and out to ensure it meets FCCH requirements. The applicant is requesting to provide care for children ages six months to thirteen years of age. Applicant is requesting the days and hours of operation will be 23 hours, seven days a week.

The home is described as follows:

This is a one-story home with three bedrooms, three bathrooms, living room (main care), family room, kitchen, dining area, garage, and back yard. 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. Off-limits areas: bedrooms #2, and #3, bathroom #2, kitchen, family room, garage, and backyard. On limits: living room, bedroom #1, dining area, and bathroom #1,

Indoor:

On limits:

Living room (Main care): LPA observed tables, chairs, television, cubbies, bookrack, kitchen set and cash register toys, books, other toys, and a fireplace. The fireplace has a glass cover and is blocked by a bookrack. The outlets are covered.
Bedroom # 1 (Nap room, adjacent to the living room): LPA observed a crib, four foldable beds, an open closet which contains pillows and blankets. The closet has a cabinet which contains diapers, diaper changing

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE	FACILITY NUMBER: 197700913
	VISIT DATE: 02/20/2025

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pads, and wipes. The first aid kid is placed on the shelf of the closet. The outlets are covered.
Dining area: LPA observed dining table, chairs, and a water dispenser. The dining area will be used as an isolation area for children with symptoms of illness. The outlets are covered.
Bathroom #1: LPA observed toilet, shower, faucet, and sink and are in operable conditions. 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. The outlets are covered.
Electrical outlets: Outlets in on-limit areas have child safety plastic plugs.

Off-limit area

Bedroom # 2 (Master bedroom, located adjacent to bedroom #3): Bedroom #2 was equipped with a Cali king-sized bed, drawers, television, closet, and other personal furnishings. LPA observed medications inside the drawers. Bedroom #2 has a bathroom (bathroom #2). LPA observed toilet, shower, faucet, and sink and are in operable conditions. Bedroom #2 does not have child safety cover for the doorknob. Applicant was advised to put child safety covers for the doorknob.
Bedroom # 3 (Adjacent to bedroom #2): Bedroom #3 was equipped with a full-size bed, drawers, vanity mirror with drawers, open closet, and other personal furnishings. Bedroom #3 does not have child safety cover for the doorknob. Applicant was advised to put child safety covers for the doorknob.
Kitchen: (Located adjacent to the living room and family room). LPA observed stove, refrigerator, dishwasher, microwave oven, and water dispenser. The outlets in the kitchen have child safety covers. Knives are stored inside the upper kitchen cabinets without child safety latch. Applicant was advised to make the knives inaccessible to children in care. Cleaning compounds are stored inside the lower kitchen cabinets under the sink and without child safety latch. Applicant was advised to make the cleaning compounds inaccessible to children in care. Per applicant, meals and snacks will also be provided to children in care. LPA told the applicant that if food was brought from children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated.
Family room: LPA observed couches, cabinets with a glass door, and a small countertop. There are three coffee makers placed on the small countertop of the family room. The outlets are covered.
Garage: The attached garage has generators, television, shelves for storing items, and household items. LPA also observed eight cots inside the garage. The garage does not have child safety cover for the

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE	FACILITY NUMBER: 197700913
	VISIT DATE: 02/20/2025

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doorknob. Applicant was advised to put child safety covers for the doorknob.
Laundry room: The laundry room contains washer, drier, and other cleaning compounds. The laundry room has no child safety doorknob cover. Applicant was advised to put child safety cover for the doorknob.
Backyard and Side yard: Per applicant, she does not have body of water at the backyard. LPA did not observe body of water at the backyard. Per applicant, the backyard will be currently off limits for children in care. The outdoor is made up of concrete and dirt. LPA observed a gardening tools like rake and shove and barbeque grill with propane tank attached to the grill. Applicant was advised to make the gardening tools and the barbeque grill inaccessible to children. The air-conditioning unit fan has no cover. Applicant was advised to put a cover for the air-conditioning unit fan. Applicant stated that she is planning on removing the wooden fence which is located on the right-side yard of the home.
Napping equipment: LPA observed eight cots and a crib inside bedroom #1.
Weapons or Firearms: Per the applicant there are zero firearms or weapons. LPA did not observe any weapons or firearms.
Knives: Stored inside the upper kitchen cabinet without child safety latch.
Poisons, Detergents and Cleaning compounds: Cleaning compounds were observed in the lower cabinets of the kitchen without child safety lock/latch.
A smoke detector and a carbon monoxide detector: Tested at 11:07 A.M. Carbon monoxide detector and smoke detector is in operable condition.
Fire extinguisher (2-A:10-B:C): The fire extinguisher is a 2-A:10-B:C type and meets the State Fire Marshall standards.
First Aid Kit: LPA observe the first aid kit stored on the shelf of bedroom #1. Applicant has a non-contact thermometer.
Pets: LPA observed two pets (dogs) inside the home. Applicant provided the LPA with copies of the pets vaccination records.
Medications: Stored inside the drawers in bedroom #2.
Documentation:
Applicant completed the Prevented Health and Safety Training with the nutrition component on July 24, 2016. Applicant took a separate training for the lead poisoning prevention on September 24, 2020. Applicant has completed the pediatric CPR and First Aid Training on January 6, 2024, and mandated reporter training

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE	FACILITY NUMBER: 197700913
	VISIT DATE: 02/20/2025

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on June 18, 2024. Applicant and one adult living in the home have fingerprint clearance. Applicant was not yet associated to the current facility number. Applicant has required immunizations (Pertussis and Measles), and TB skin test. The other adult living in the home has chest x-ray results.

The applicant provided proof of control of property which is the Mortgage Loan Statement with a statement date of December 13, 2024. Fire clearance was granted on February 6, 2025.

Per Applicant, transportation will be provided.

The following was discussed with the applicant:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both.

2 Pediatric First Aid and CPR: American Heart Association or American Red Cross or Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR must be present. Certification must be renewed every two years.

3. Applicant was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

4. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

5. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE	FACILITY NUMBER: 197700913
	VISIT DATE: 02/20/2025

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6. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

7. The fire extinguisher type 2-A:10-B:C must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

10. Children and staff records must be maintained and updated as needed and be available for review by the Department.

11. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home). The dining area will use as an isolation area.

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information. Licensee is planning to have a liability insurance.

16. Dog(s) and/or pets are recommended to be isolated from children in care.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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: GOMEZ-CASTILLEJOS FAMILY CHILD CARE	FACILITY NUMBER: 197700913
	VISIT DATE: 02/20/2025

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17. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

18. The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Mandatory licensing forms such as LIC 311D Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, 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 applicant was reminded that 100% supervision is required at all times to children in care; Applicant 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 applicant was made aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and to the Department on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. The applicant was informed to utilize the Unusual Incident Report/Injury Report form (LIC624B) when sending the report to the department. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Applicant was informed that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

Page: 6 of 9

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: 197700913
	VISIT DATE: 02/20/2025

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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 applicant and discussed the Child Care Licensing Safe Sleep webpage: atttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed applicant 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.

The applicant 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, 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.

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: Building an in-ground or above-ground swimming pool, 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

Page: 7 of 9

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: 197700913
	VISIT DATE: 02/20/2025

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

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the CCLD website at: https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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

LPA checked Megan’s Law website and confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

As a result of this inspection, the home does not meet Title 22 Regulations. Final approval is pending the following:

1. Physical Plant – A new facility sketch shall be provided.

2. Physical Plant – 102417(g): Applicant will install child safety cover for the doorknobs in the off-limits bedrooms.
3. Physical Plant – 102417(g)(4): Cleaning compounds stored in the lower cabinets without child safety lock/latch shall be made inaccessible.
4. Physical Plant – 102417(g)(4): Kitchen knives stored in the upper kitchen cabinets without child

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

Page: 8 of 9

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: 197700913
	VISIT DATE: 02/20/2025

NARRATIVE

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safety lock/latch shall be made inaccessible. Kitchen stove knobs shall have child safety covers. A child safety baby gate separating the kitchen (off-limits) and dining are (on-limits) shall be installed.
5. Physical Plant – 102417(g)(4): Garden tools shall be made inaccessible. The barbeque grill with propane tank shall be made inaccessible. Air conditioning unit fan shall have a cover.

Applicant will send the corrections on February 25, 2025.

An exit interview was conducted, and a copy of this report and appeal rights were discussed with the Applicant, Monica Gomez-Castillejos.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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