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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843790
Report Date: 06/10/2025
Date Signed: 06/10/2025 02:29:31 PM

Document Has Been Signed on 06/10/2025 02:29 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: DATE:
06/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Tierra Burrell, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On June 10, 2025, Licensing Program Analyst (LPA) Annelise Villa met with Licensee Tierra Burrell, 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 30, 2025. This Unusual Incident was self-reported. LPA discussed reporting requirements, pursuant to California Code of Regulations (CCR) Title 22, Section 102416.2 to ensure all reportable unusual incidents are reported within specified time frames. Upon arrival LPA observed 13 children in care, along with 3 staff including the Licensee caring for them.

Description of incident #1: On May 30, 2025, at approximately 12:15 Parent #1, came to the family childcare home to drop off items for child #2. Upon arrival, child #1 heard their parent’s voice (Adult #1), and became distressed when Adult #1 left. Child #1 began to scream and cry. Staff #1 consoled Child #1, however, Child #1 began scratching themself and pulling their hair. Staff #1 consoled Child #1 and provided Child #1 with a snack and placed in a highchair. Due to Child #1 harming themself by scratching thier face and pulling their hair. During the tantrum, Child #1 was placed in the highchair to eat and prevent further injury. Staff #1 stated Child #1 was no longer harming himself but still crying and squirming in the highchair. After about 10 minutes, Child #1 was calm and a diaper change was conducted. Child #1 was then placed back into the highchair to watch a movie, and fell asleep. Staff stated child #1 remained asleep in the highchair and proceeded with the rest of the day as normal. At night, Parent #1 reported to Licensee Child #1 had two bruises on their upper thighs. Staff #1 and Licensee stated the bruising was consistent with the tray from the highchair when Child #1 was sitting in. LPA took pictures of the highchair and obtained photographs of the bruising.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2025
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: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 06/10/2025
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During the inspection, LPA interviewed staff, Licensee, and children and gathered documents to aide in the unusual incident follow up. Interview with Licensee and Staff #1 revealed high chairs are not regularly used for children and was not intended to restrain child, rather to provide a safe space to calm down while eating. Licensee acknowledged that Child #1 should have been moved and will refrain from utilizing the highchair in this manner. Licensee has been proactive and is currently taking courses on managing difficult behaviors in children and will continue to apply new strategies and methods to prevent similar incidents in the future. Licensee communicates best practices to staff and will provide training with staff on managing challenging behaviors.

A type B citation was given as a result of Child #1 sleeping in the highchair without being moved to a cot or mat. 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.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2025 02:29 PM - It Cannot Be Edited


Created By: Annelise Villa On 06/10/2025 at 01:49 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: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
102423(a)(2)

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Personal Rights. Each child receiving services from a family child care home shall have certain rights...these rights include...To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.. This was not met as evidenced by:
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Licensee shall not allow daycare children to sleep in a highchair. Additionally, Licensee and all staff will participate in training regarding managing challenging behaviors.
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Child #1 was placed in a high chair with a snack. After eating, child fell asleep. Staff did not move the child from the highchair. This is a potential risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Annelise Villa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
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