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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843790
Report Date: 07/03/2024
Date Signed: 07/03/2024 01:24:47 PM

Document Has Been Signed on 07/03/2024 01:24 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:BURRELL FAMILY CHILD CAREFACILITY NUMBER:
364843790
ADMINISTRATOR/
DIRECTOR:		BURRELL, TIERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 362-3565
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:52 AM
MET WITH:Tierra Burrell, LicenseTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On July 3, 2024, Licensing Program Analysts (LPA) Annelise Villa met with Licensee Tierra Burrell who guided analyst on a tour of the facility for the random annual inspection. Upon arrival, LPA observed 11 children in care with Licensee, 1 assistant, and 2 volunteers caring for them. Family members living in the home are Licensee, Licensee’s husband, and 4 minor children. Hours of operation are 6:00 am to 6:00 pm, Monday through Friday. Incidental Medical Services (IMS) policy was discussed. No children in the daycare with IMS.

Physical Plant: This is a single story 4 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. The primary care is conducted in the family room near the entrance of the home. Children will have access to family room, kitchen, dining area, bathroom #1 located in the hallway, and back yard. The off-limit areas of the home include bedrooms #1-4, bathroom #2-3, living room, garage made inaccessible with a key lock, laundry room. and front yard. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, and medicines. Hazardous items (sharp knives are stored in an upper kitchen cabinet, cleaning detergents/compounds are stored in the laundry room, and medications are stored in an off limits area) are inaccessible to children in care.

Safe and age-appropriate toys, play equipment and materials were observed. LPA tested the smoke detector and carbon monoxide detector and observed both to be in operable condition. Fire extinguisher (2A10BC) was observed to be in operable condition in the hallway. Electrical outlets were inaccessible. No recalled and or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary.


Continued on LIC 809-C
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 07/03/2024
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Bathroom: Bathroom #1 is located in the hallway. The toilet and sink are in operable condition. Bathroom #1 is equipped with a standup shower. The bathroom was observed to be free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet are clean and operable.

Kitchen: The home has a clean and fully stocked clean refrigerator/freezer. The kitchen was observed to be clean and sanitary. Breakfast, lunch, dinner, and snacks are provided. Licensee was reminded all food items brought from the children’s home shall be properly stored, labeled, and dated. Licensee is a participant in a food program. Sharp items are stored in an upper kitchen cabinet and inaccessible to children in care.

Outdoor: Children play in the back yard. The play area is clear and clean of debris, play area is fenced and gated all around. LPA observed the back yard to be accessible through a door in the living room which remains locked while children are not outside. LPA observed the outdoor air conditioner in the backyard accessible. LPA observed age appropriate toys for children.

Pools/Spas/Bodies of Water: There are no pools, spas, or bodies of water on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available in the entry way. Licensee’s First Aid/CPR is valid and expires on 8/2025. Licensee’s Mandated Reporter training expires on 7/7/2024. LPA reminded licensee mandated reporter training and First Aid/CPR must be completed every 2 years. Licensee was advised online First Aid/CPR courses cannot be accepted and all in person courses must be EMSA approved. For more information about First Aid/CPR courses, please visit, https://emsa.ca.gov/childcare_provider/. Per Licensee there is 1 dog on the premises. Additionally, Licensee stated there is no smoking of any kind in the home. Last fire/disaster drill was conducted on 6/6/2024.

Licensee’s annual fees are current. LPA observed all required facility postings on premises. Licensee had the following required posted documents: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203) and Emergency Disaster Plan (LIC 610A), and Fire/Disaster Log.

Documents Provided and or Discussed: Earthquake Preparedness Checklist (LIC 9148), Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227).

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 07/03/2024
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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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

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: 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep. More information on Infant Safe Sleep procedures can be found online on the CDSS web page 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 PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 07/03/2024
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Licensee 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, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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/process

Exit interview conducted, and report was reviewed with the licensee. A notice of site visit was given and must remain posted for 30 days. No citation was given today as a result of this inspection.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
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