364817663-3-21-2024-12-CC-APIN-D3KPSM-20240321113435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364817663
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:34:49 AM

Document Has Been Signed on 03/21/2024 11:34 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:	HAEFELE FAMILY CHILD CARE		FACILITY NUMBER:	364817663
ADMINISTRATOR:	HAEFELE, MELISSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 265-2453
CITY:	BARSTOW	STATE: CA	ZIP CODE:	92311
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	03/21/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Licensee Melissa Haefele		TIME COMPLETED:	12:00 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 3/21/2024 at 8:50am, Licensing Program Analysts (LPAs) Andrea Pittman and Sherell Braddock conducted an unannounced annual inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPAs observed 5 children in care and the Licensee and one staff providing care and supervision (fingerprint cleared and associated to the facility.) The operational childcare hours are Monday through Friday from 5:00am to 5:30pm. This is a one-story family home. There is a living room, middle room, play room, kitchen, three bedrooms, two bathrooms, laundry area, and attached garage but not accessible from inside the home with a safety knob. Licensee does provide napping, there are 15 cots and one play yard. The off-limits areas are the three bedrooms, second bathroom, and garage. Licensee provides breakfast, lunch, and snacks; parents bring store bought food but children can also bring food from home and is placed in a refrigerator for the child care. 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. Hanging window blind cords: The cords are inaccessible to children; however, some of the blinds are damage, technical assistance was provided. Pets: there are two dogs on premises; Licensee attests there are no other animals on site and the dogs have been fully vaccinated. Phone service: There is a cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does provide transportation for children, Licensee was made aware they must always have a valid driver license, insurance, and vehicle registration. Isolation occurs in the middle room for children in care showing signs of illness. The calming area is located in the room with the Licensee. There is a fireplace that is screened and inaccessible to children in care; Licensee declares that they do not use it and it has not been used in years.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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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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: HAEFELE FAMILY CHILD CARE	FACILITY NUMBER: 364817663
	VISIT DATE: 03/21/2024

NARRATIVE

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Knives are kept in the kitchen in a high cabinet, inaccessible to children in care. Medication is kept in the kitchen in a high cabinet, inaccessible to children in care. Cleaning supplies and chemicals are kept locked under the sink inaccessible to children in care.

There are age-appropriate toys and equipment on the premises. The outdoor area is off-limits per the Licensee and the Licensee states the outdoor play occurs in the nearby park instead of at the facility; Licensee declares that they have attained written permission from the Parents to take the enrolled children to the nearby park for outside play. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPAs did not observe any weapons. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, adhesive tape, and cleansing pads/solution was observed to be complete and inaccessible to children kept in a high cabinet in the kitchen. The required fire extinguisher (3A40BC) is reading in the green. Smoke and carbon monoxide dual detector was found to be in operable condition, tested at 9:55am. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 2/13/2024 at 9:30am.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), PUB 269 Child Passenger Safety Law, PUB 515 Risks & Effects of Lead Exposure, and Earthquake Preparedness Checklist (LIC 9148).

Licensee does not have insurance on the family child care home and has the parents complete the LIC 282-Affidavit Regarding Liability Insurance for Family Child Care Homes.

The Licensee provided proof of immunization against pertussis (TDAP), measles (MMR), TB, and Influenza vaccination/statement declining the Influenza for self, spouse/owner, and staff.

Licensee was able to provide a valid Pediatric CPR/First Aid training expiring in 1/2026. Child Care Provider Mandated Reporter Training Certificate has been completed and expiring in 10/2025. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Training, Immunizations: MMR, Tdap, TB, & Flu statements declining the Flu shot, and background clearances.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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: HAEFELE FAMILY CHILD CARE	FACILITY NUMBER: 364817663
	VISIT DATE: 03/21/2024

NARRATIVE

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Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information, School enrollment forms, and PM 286-California School Immunization Record.

Licensee's facility child roster is current and maintained up to date.
The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed the 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. Provided Licensee with the sleep log.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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: HAEFELE FAMILY CHILD CARE	FACILITY NUMBER: 364817663
	VISIT DATE: 03/21/2024

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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.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child

Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and the RSO profile was completed in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates, please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & call at (916) 654-1541.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was found to be in compliance per Title 22 regulations, no deficiencies will be cited today. An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Licensee.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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