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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842256
Report Date: 07/31/2024
Date Signed: 07/31/2024 12:45:09 PM

Document Has Been Signed on 07/31/2024 12:45 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:GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
364842256
ADMINISTRATOR/
DIRECTOR:
GUZMAN, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 550-7606
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/31/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:44 AM
MET WITH:Brenda GuzmanTIME VISIT/
INSPECTION COMPLETED:
12:59 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye met with Licensee Brenda Guzman who guided analyst on a tour of the facility for a room addition Inspection. This is a single story 7-bedroom, 4-bathroom home with 2 kitchen,2 living room, 2 dining room, laundry, and garage (detached). Upon arrival LPA observed 8 children in care with Licensee, two assistants (spouse and assistant) present during the inspection. There is no pool/spa or body of water on the premises. Family members residing in the home include 3 adults (licensee , licensee spouse and adult grandson) Incidental Medical Services (IMS) policy was discussed.

Main care is provided in the living room #1, bedroom #1, #2, bathroom #1, dining #1 and backyard. Off limit areas include the Living room #2 Bedrooms #3, #4, #5, #6 and #7, bathroom #2,#3 and #4,dining #2 laundry area and detached garage.

The city of Hesperia granted the permit for the residential room addition on 11/18/2022 with permit # RES22-00094. Fire clearance granted for LARGE FAMILY CHILD CARE HOME 14 total on 07/18/2024.

Daycare equipment was evaluated. There are no "bodies of water" or firearms in this home. Operable 2A10BC fire extinguisher, smoke alarm, and carbon monoxide detector are operable and in place. Heat and air are available. LPA observed safe toys, safe indoor and outdoor play areas, and child safety plugs in unused electrical outlets. The home was inspected inside and out for safety, comfort, and cleanliness.

The licensee was informed that in the future if any other adult moves in and lives in this home they must be live scan cleared and TB cleared. The assistant providing care/supervisor also needed to be fingerprinted and cleared, TB cleared, immunized against influenza, pertussis, and measles, and complete the online mandated reporter training. The licensee has current CPR and First Aid Training. LPA discussed the practice of fire drills at least every 6 months, and documented the time and who was present. The licensee documented fire drill was conducted on (06/04/2024). Fire clearance was granted on (07/18/2024).

Planned hours of operation are Mon-Fri from 6:30 a.m. to 5:30 p.m.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364842256
VISIT DATE: 07/31/2024
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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

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). 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.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to part obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364842256
VISIT DATE: 07/31/2024
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was reviewed and provided to the licensee Brenda Guzman .

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC809 (FAS) - (06/04)
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