<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814947
Report Date: 11/29/2021
Date Signed: 11/29/2021 05:21:17 PM

Document Has Been Signed on 11/29/2021 05:21 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:BARNES FAMILY CHILD CAREFACILITY NUMBER:
364814947
ADMINISTRATOR:BARNES, DIANEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 241-5599
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Diane BarnesTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/29/2021, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1 Year inspection at the above facility. Upon arrival, the LPA met with licensee Diane Barnes, who guided the LPA on a tour of the facility. Individuals that reside in the home include licensee, her spouse, and a child (daughter age 15). All adults living in the home have been background cleared. Per LIS, facility annual fees are current. Per licensee, the hours of operation are Monday through Friday 6:00 a.m. to 6:00 p.m. Present today are Licensee, her assistant Larissa Arroyo-Catuto and 5 children ( 1 Toddler, 0 Infant, and 4 children (2 children are 7 years old, 1 child is 4 years old, 1 child is 3 years old and 1 child is 2 years old )observed under care.

The Home is set up as follows:
This family childcare facility is a single home 5 bedrooms, 2 bathrooms with kitchen, living room, dining room, playroom, and attached garage. The garage was observed to be locked, it has a security latch on top of the door and a key bolt. The garage is used for storage only, the garage is off limits to children. The garage is located in the playroom. There is a spa or body of water on the premises.

Main Area: living room, playroom, and backyard

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating, and ventilation. Poisons, detergents, cleaning compounds medicines, and hazardous items can pose a danger to children.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2021
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 8
Document Has Been Signed on 11/29/2021 05:21 PM - It Cannot Be Edited


Created By: Carol Heath On 11/29/2021 at 12:11 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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 364814947

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee and her assistant did not comply with the Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2021
Plan of Correction
1
2
3
4
The licensee and her assistant will take the Mandated Reporter Training by 12/01/2021.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2021


LIC809 (FAS) - (06/04)
Page: 2 of 8
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 364814947
VISIT DATE: 11/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
· Playroom: LPA observed age-appropriate toys and furniture for the children. A small table was observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. A small play kitchen was located by the door with which children can play. There are games and books on the premises of this facility. There are mats on the floor that have educational/learning activities on them. The mats were observed to be in good condition. There is a security gate that separates that living room from the day-care room and another security gate was observed on the staircase that prevents children from accessing the upstairs bedroom.

· Living Room: In the Living room a fireplace was observed that was properly screened via mirror glass doors and inaccessible to children. In the Living room, there were additional toys observed to be in the room stored on cubbies.

· Kitchen: The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). LPA observed proper storage of all cleaning detergents, medications, and sharp-pointed objects. LPA observed licensee keeps knives and sharp objects underneath the cabinet sink. The sink underneath the cabinet was observed to have a child proof lock on it. All sharp objects and knives are inaccessible to children. The medications are kept in the kitchen in the upper kitchen cabinets.

· Bathroom #1: Children utilize a bathroom that located in the hallway near the kitchen. The bathroom was observed to be free and clear of hazardous items. The bathroom was observed to have working toilet, sink, and an ample supply of towels and soap accessible for the children to use. Inside the cabinet underneath the sink LPA observed toilet paper.

· Backyard: Child have access to the backyard area. The backyard is surrounded wood fencing that is over 5 ft high. LPA observed that there were a good supply of toys in which the children can play with. LPA observed bikes, basketball stand and other toys. There is a trampoline located in the backyard licensee states that children are not allowed to go on the trampoline. Declaration obtained regarding trampoline.

Ø Off limit include: All Bedrooms(#1-#5), Bathroom #2, garage and laundry room.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 364814947
VISIT DATE: 11/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Ø Others:
· AC/Heating Unit was observed. AC/Heating Unit is located on the right side of the home is inaccessible to children via barrels blocking access to the unit.
· Napping: Children will nap in the designated nap areas with adult supervision. LPA observed 8 Mats.
· The First Aid kit is located in the kitchen inaccessible to children on top of the refrigerator. The First Aid Kit was observed complete with supplies and a first aid manual.
· Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (2A10BC) fully charged Date: 2018 and located in the living room closet inaccessible to children.
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices were tested and in operable condition.
· Fireplace: There is a fireplace in the living room area. It has a metal barrier screen to make it inaccessible to children.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Bodies of water: There a spa on premises at this facility, licensee was asked to stand on top of spa cover during the time of this inspection. Spa cover was observed to support the weight of the licensee. Spa was observed to be locked. There is a key that unlocks spa cover, the spa cover is securely secured in place so that a child cannot slip under or undo. Licensee has an alarm that alerts her when the door to the back yard is accessed. The alarm will chime when opened.
· Medications and cleaning solutions are stored in the Master bedroom cabinet which it made inaccessible to children.
· Weapons or Firearms: Per licensee, there are no firearms present at this facility.
· Meals: According to License she is currently participating in a Nutrition Food Program. The daycare home provides breakfast, morning snacks, lunch, and an afternoon snack.
· Incidental Medical Services (IMS): 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing medication to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 364814947
VISIT DATE: 11/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Ø Documentation:

· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (09/2021) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Immunization: Licensee does not have proof of being immunized against measles. Her staff does not have proof of being immunized against pertussis, and measles. The licensee provided a written statement declining the influenza vaccination.
· Mandated Reporter Training: The licensee did not complete the online mandated reporter training at www.mandatedreporterca.com for every 2 years. The licensee will renew by 12/1/2021
· Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license with an expiration date of 05/16/2022. Licensee has valid vehicle insurance with the expiration date of 06/12/2022 and vehicle registration dated 01/16/2022.
· Child files: LPA observed 10 children's files contained all required licensing documents.
· Staff File (For Large FCC Only): The assistant needs to renew her CPR/First Aid and Mandated Reporter Training.
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 07/14/2021.

· Facility Roster: LPA observed Child Care, Facility Roster. Per Licensing Information System, facility annual fees were current.

· Licensee has posted as required:

o The Facility License,

o Emergency Disaster Plan (LIC 610 A)

o Parents Rights Poster (PUB394)

o Earthquake Preparedness (LIC 9148)

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 364814947
VISIT DATE: 11/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü Criminal Record Statement: Licensee [or facility representative] 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 an 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.
ü Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 364814947
VISIT DATE: 11/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
ü Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.
ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.
ü LPA provided consultation during the inspection.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.


An exit interview was conducted, and the report was reviewed with the licensee Diane Barnes.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
Page: 8 of 8