364841901-6-5-2025-12-CC-AVIA-DHCS76-20250605133700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364841901
Report Date: 06/05/2025
Date Signed: 06/05/2025 01:38:34 PM

Document Has Been Signed on 06/05/2025 01:38 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:	ARCHILA FAMILY CHILD CARE		FACILITY NUMBER:	364841901
ADMINISTRATOR/ DIRECTOR:	VILMA ARCHILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 628-6705
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	06/05/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Vilma Archila, Licensee		TIME VISIT/ INSPECTION 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 June 5, 2025, Licensing Program Analyst (LPA) Annelise Villa met with Licensee Vilma Archila, who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident inspection regarding an incident that occurred on May 29, 2025. This Unusual Incident was self-reported. LPA discussed reporting requirements, pursuant to California Code of Regulations (CCR) Title 22, Section 101212(d), to ensure all reportable unusual incidents are reported within specified time frames. Upon arrival LPA observed 3 preschool age children and 1 infant, along with Licensee and 1 staff caring for them. Description of incident: On May 29, 2025, Licensee was preparing breakfast for Child #1 in the kitchen. Child #1 was in the connected living room playing with the family dog, approximately 10 feet away. Licensee was in close proximity to the child and stated she did not hear or see the incident occur. While preparing for school drop off, Child #1 disclosed the dog bit her on the nose about 30 minutes prior. Licensee observed a scratch approximately 1 inch in length on the child's nose. Licensee stated child did not cry, express fear, or note any pain. The wound did not bleed and there was minimal redness. Licensee immediately provided first aid to the area, took photographs to document, and notified the child's parent. LPA conducted a record review of child's file and reviewed dog vaccination record and license with the City of Victorville. All vaccinations for the dog are up to date. Child's file was maintained current. Child returned to the family childcare home the following day. In response, Licensee immediately removed the dog temporarily from the home and stated once the dog returns, the dog will remain in another room or outside while daycare children are present. Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: ARCHILA FAMILY CHILD CARE	FACILITY NUMBER: 364841901
	VISIT DATE: 06/05/2025

NARRATIVE

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LPA discussed the following best practices with Licensee regarding pets in the childcare setting:

• Before bringing and introducing any animal, learn about the usual behavior of that type of animal and get to know the individual pet. Since children’s behavior can threaten an animal, be sure you know how the animal behaves when frightened.
• Make sure that children are introduced to pets in a quiet, controlled setting.
• Teach children how to behave around pets. They need to learn not to feed or provoke the pet, and that removing the pet’s food or disturbing a sleeping pet upsets them. Always keep their faces and fingers away from a pet’s mouth, beak or claws.
• All pets, whether kept indoors or outside, must be in good health, show no evidence of disease, and be friendly toward children.
• Child care providers must be present when children play with animals. Be ready to remove a child immediately if an animal shows signs of distress or the child treats the animal inappropriately.
• Keep pet food and dishes out of children’s reach.
• Do not let children pet an animal that is in a cage/kennel

Licensee was provided with Health & Safety Notes, California Childcare Health Program article "Pets in the Childcare Setting" for more information and best practices to take action to prevent further incidents. Technical assistance was given to Licensee, see attached LIC 9102. Licensee understands that she must provide a safe environment for day care children and she is responsible for child safety around pets at all times. Reporting requirements for the incident were met.

An exit interview was conducted and a copy of this report was provided to the Licensee, along with a Notice of Site Visit and appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

LIC809 (FAS) - (06/04)

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