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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808632
Report Date: 08/16/2023
Date Signed: 08/16/2023 11:50:04 AM

Document Has Been Signed on 08/16/2023 11:50 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: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: 14CENSUS: 8DATE:
08/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee, Monica Duran TIME COMPLETED:
12:00 PM
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On August 16, 2023 at 8:15 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Required one year inspection and met with Licensee, Monica Duran. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Eight children (three infants and five children over the age of two), the Licensee and one assistant were present in the facility during this inspection.
This is a tri level house with four bedrooms, three bathrooms, kitchen, dining room/classroom, playroom, attached garage and backyard. Per Licensee the playroom, dining room/classroom, kitchen, bathroom (entry level) and the office (second floor) is utilized for family child care activities. Per licensee off-limit areas of the home include all bedroom on the second level of the home except the office, and the garage. Due to the winter storm the home sustained damage to the decks. The Licensee has ensured the children do not have access to the deck area, by the locking doors and the sliding door leading to the deck area. In addition, the handle of the sliding door has been removed, and the door leading to the deck has an additional door latch. The off limit areas were inaccessible via child safety gates. All stairs in the home are inaccessible via child safety gates. Currently living in the home is the Licensee. Current days and hours of operation are 24 hours a day, 7 days a week.
At approximately 09:00 a.m. LPA and Licensee started the physical plant inspection.
Physical Plant: 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. During the tour LPA observed cleaning products under the kitchen sink. The cleaning products were removed and relocated to an inaccessible location during this inspection. LPA reminded the Licensee that all Poisons, detergents, cleaning compounds and hygiene products labeled keep out of reach of children must be inaccessible to the children in care. Sharp knives were stored a cabinet above the stove. Medications were stored in a high inaccessible cabinet in the kitchen. Per recorded documentation Fire/earthquake drills were last completed in July 2023. LPA observed a 2A10BC fire extinguisher located in the pantry. The fire extinguisher was serviced in April 2023.
Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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: DURAN FAMILY CHILD CARE
FACILITY NUMBER: 364808632
VISIT DATE: 08/16/2023
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Report continued from page one

Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were observed on the entry level of the home. Electrical outlets were inaccessible. Baby bouncers, saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were not observed on the premises. The kitchen is the designated area for ill children in the child care.

Per Licensee, there zero firearms stored in the home. The home has fireplace in the living room, which was inaccessible via a gate. The home has central heating and air conditioning.

Bathroom (located on entry level): Toilet, sink, faucet were clean and operable. LPA reminded the Licensee that all personal care items labeled "Keep put of reach of children" must be inaccessible tot he children in care.

Outdoor: The backyard is utilized for child care activities. The area is enclosed by a gate. LPA observed a climbing structure that was secured to the ground. Outdoor play space was free of hazards at the time of this inspection.

Per Licensee and LPAs observation there are two dogs in the home. The dogs interact with the childcare children. Licensee reported the dogs are current on shots.

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.


LPA reviewed a total of five child files and two personnel records. Based on LPAs review one advisory notice was provided for the child files. Based on LPA review, of the personnel records, two of two personnel records did not contain immunization paperwork (TB, Measles, TDAP/pertussis, Flu). A type B citation was issued, refer to LIC 809D. In addition, LPA reminded the Licensee to place a copy of the Child Care Specific Mandated Reporter training in the file.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep.

Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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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: DURAN FAMILY CHILD CARE
FACILITY NUMBER: 364808632
VISIT DATE: 08/16/2023
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The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/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



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

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

Report continued on page four
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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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: DURAN FAMILY CHILD CARE
FACILITY NUMBER: 364808632
VISIT DATE: 08/16/2023
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Report continued from page three

To improve the quality and value of the new inspection process, a survey will 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 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 Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Deficiency are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. In addition, advisory notices were issued.



A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Monica Duran.


SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/16/2023 11:50 AM - It Cannot Be Edited


Created By: Kendal Zirbes On 08/16/2023 at 10:31 AM
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: 08/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above when two of two staff files were missing documentation of the required immunization's which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2023
Plan of Correction
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Per Licensee, the immunization records will be added to the files. Licensee will send the Department a copy of the immunization's once received. The Licensee will utilize the LIC 311 to ensure all records are complete.
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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023


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