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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808632
Report Date: 12/08/2021
Date Signed: 12/08/2021 06:21:58 PM

Document Has Been Signed on 12/08/2021 06:21 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:DURAN FAMILY CHILD CAREFACILITY NUMBER:
364808632
ADMINISTRATOR:DURAN, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 337-7739
CITY:LAKE ARROWHEADSTATE: CAZIP CODE:
92352
CAPACITY: 14TOTAL ENROLLED CHILDREN: 32CENSUS: 17DATE:
12/08/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Licensee Monica DuranTIME COMPLETED:
06:30 PM
NARRATIVE
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 On December 08, 2021 at 09:30am Licensing Program Analysts (LPA) Zirbes met with Licensee. LPA was on grounds for other purposes. When LPA Zirbes arrived on grounds at 9:30am there was a total of 17 childcare children, one staff member and the Licensee.

During this inspection, LPA reviewed child files and gathered documentation related to the above deficiency. Licensee also confirmed there was a total of 17 children on site. LPA observed a total of six children under the age of 24 months.
The home is currently license as a large family childcare home with a maximum capacity of 14 children. Based on LPAs observation, Licensee statements and additional evidence gathered the facility is being cited for being over capacity as the Licensee was caring a total of 17 children when LPA arrived on site at 9:30am. By 10:00 am the facility had a total of 14 children. Furthermore, the facility is being cited for being outside of the licensed ratio. Based on LPA's observation and record review there was a total of four infants in care and a total 14 children. A large family home may only care for 12 children, no more than three of whom may be infants. or twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code. Per Health and Safety Code the large family childcare may care for no more then three infants during any time when more than 12 children are being cared for. Therefore, the facility was out of ratio when 14 children and four infants were being cared for.
In addition, during this inspection LPA observed the child 8 and child 13, both infants were sleeping in swings. Per infant safe sleep regulations, if an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.
Based on LPA observations, Licensee statement, and additional evidence, there is a preponderance of evidence to prove that the facility was out of ratio, over capacity and was not meeting the infant safe sleep regulations. During this inspection. LPA Zirbes printed and provided the Licensee with a copy of the infant safe sleep requirements.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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 4
Document Has Been Signed on 12/08/2021 06:21 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 12/08/2021 at 03:06 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: DURAN FAMILY CHILD CARE
FACILITY NUMBER: 364808632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/09/2021
Section Cited
CCR
102416.5(f)

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 102416.5(f) Staffing Ratio and Capacity: The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children. This requirement was not met as evidenced by: Based on LPA observation, and interviews, on December 8, 2021, LPA arrived on site at 9:30am.
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Per Licensee, the children's scheduling will be changed so they are coming and going at different times. The children will not over lap in pick up times.
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LPA observed a total of 17 children. This number exceeds the licensed capacity. This poses a immediate Health, Safety or personal right risk to the children in care.
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Type A
12/09/2021
Section Cited
CCR102416.5(d)(2)

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102416.5(d)(2) Staffing Ratio and Capacity: More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met. This requirement was not met as evidenced by: On
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Per Licensee, we will be within ratio depending on if we have 12 or 14 children.
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 December 8, 2021, LPA observed a total of 14 children, four of whom were infants. This exceeds the ratio which states there can be a total of 12 children when three infants are present. This poses a immediate Health, Safety or personal right risk to the children in care.
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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:Carissa Bell
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2021


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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DURAN FAMILY CHILD CARE
FACILITY NUMBER: 364808632
VISIT DATE: 12/08/2021
NARRATIVE
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Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

A plan of corrections and Appeal rights were reviewed and discussed with the provider.
A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, a copy of this report, and notice of site visit were provided to the Licensee.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/08/2021 06:21 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 12/08/2021 at 04:14 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: DURAN FAMILY CHILD CARE
FACILITY NUMBER: 364808632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/09/2021
Section Cited
CCR
102425(i)

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102425(i) Infant Safe Sleep: If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This requirement was not met as evidenced by: LPA observed the infants in care fell asleep in swings and high chairs.
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Per Licensee, now that we are aware of the new rules, infants will be removed and placed in cribs or play yards.
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The licensee and assistant did not take action to move the infants to a crib or play yard as soon as possible, This is an immediate risk to the health, safety or personal rights risk to the children in care.
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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:Carissa Bell
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2021


LIC809 (FAS) - (06/04)
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