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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808486
Report Date: 12/27/2024
Date Signed: 12/27/2024 02:53:38 PM

Document Has Been Signed on 12/27/2024 02:53 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:FOWLIE-PETERS FAMILY CHILD CAREFACILITY NUMBER:
364808486
ADMINISTRATOR/
DIRECTOR:		FOWLIE-PETERS, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 951-5770
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
12/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:52 AM
MET WITH:Linda Fowlie-PetersTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 12.27.24, Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced inspection at the facility, LPA was greeted by Licensee, Linda Fowlie-Peters who granted access and guided LPA on a tour. The purpose of the visit was to follow-up on an Unusual Incident that was received at Palmdale RO on 12.13.24. Upon arrival LPA observed 12 children in care with the licensee including one infant. Per licensee, parent of 4 dropped off kids today that were not expected. Licensee contacted helper to come help. LPA advised licensee to contact parent of children and ask her to come get the children. Licensee's helper/volunteer Sophia Arvayo arrived at about 12:40 PM. LPA conducted a safety inspection that resulted in 1 deficiency due to non-compliance of staffing ratio and capacity.

During the inspection LPA conducted confidential interviews and gathered documents pertinent to the investigation of the incident. As reported on 12.13.24 C1 sustained an injury requiring medical attention. The incident occurred on 12.6.24 and was reported to RO on 12.13.24. Due to the holidays, parties pertinent to the investigation were not present and must be interviewed at a later date.

During the inspection, LPA issued 1 Type A and 2 Type B citations (See LIC809-D). LPA reminded licensee that she must provide a copy or ensure that a parent of each child enrolled reads this report and signs an LIC9224 for each child. Due to licensee's non-compliance LPA suggested help from the Technical Support Program (TSP). Licensee agreed that she would like to be referred to the program. LPA will send referral upon return to RO.

This inspection was conducted in person. LPA read and provided a copy of this report to the licensee, Linda Fowlie-Peters which must be posted for 30 days. LPA provided Appeal Rights and a Notice of Site Visit which must be posted for 30 days.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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Document Has Been Signed on 12/27/2024 02:53 PM - It Cannot Be Edited


Created By: Kristina Diaz On 12/27/2024 at 01:49 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: FOWLIE-PETERS FAMILY CHILD CARE
FACILITY NUMBER: 364808486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/30/2024
Section Cited
CCR
102416.5(e)

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102416.5 Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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Licensee contacted helper to come assist in the facility. Assistant arrived at approximately 12:40pm putting the licensee's ratio in compliance. Licensee will watch the following video: https://ccld.childcarevideos.org/family-child-care-providers/how-many-children-can-attend-a-family-child-care-home/
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This requirement was not met as evidenced by:
Based on observation, interview, and records review licensee was caring for 12 children with no other adult present. This poses an immediate health, safety, and personal rights risk to the children in care.
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Upon completion of the video, licensee will provide a statement of completion and send to LPAs email provided by business card by the POC due date.

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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:Claretta Yates
LICENSING EVALUATOR NAME:Kristina Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/27/2024 02:53 PM - It Cannot Be Edited


Created By: Kristina Diaz On 12/27/2024 at 02:06 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: FOWLIE-PETERS FAMILY CHILD CARE
FACILITY NUMBER: 364808486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
102416.2(a)(3)

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102416.2 Reporting Requirements
(a) The licensee shall report the following information to the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (3) Health and Safety Code Section 1597.467(b)(1)
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Based on observation, interview, and record review licensee contacted the office OD (LPA Diaz) on 12.13.24 to report an incident that occurred on 12.6.24. This is a potential health, safety, and personal rights risk to the children in care.
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provides in part: "A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:(B) Any injury to any child that requires medical treatment. This requirement was not met as evidenced by:
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Licensee will watch the following video: https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/
Licensee will provide a statement of completion to LPA's email address provided vis business card by the POC due date.
Type B
01/03/2025
Section Cited
HSC1596.841

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1596.841: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name
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This poses a potential health, safety, and personal rights risk to the children in care.
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and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
This requirement was not met as evidenced by: Based on observation, interview, and records review licensee did not comply in 10 out of 12 persons present at the facility.
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Licensee will complete the roster including all children enrolled in the facility with all required information and submit proof of completion to LPA via email at the address provided via business card by the POC due date.
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:Claretta Yates
LICENSING EVALUATOR NAME:Kristina Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2024


LIC809 (FAS) - (06/04)
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