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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700037
Report Date: 09/19/2023
Date Signed: 09/19/2023 12:54:05 PM

Document Has Been Signed on 09/19/2023 12:54 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:CROOMS FAMILY CHILD CAREFACILITY NUMBER:
367700037
ADMINISTRATOR:CROOMS, BRANDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 916-2504
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Brandi Crooms, LicenseeTIME COMPLETED:
01:00 PM
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On September 19, 2023, Licensing Program Analyst (LPA) Calloway met with Licensee, who granted access. LPA and Licensee toured the home inside and outside for an Annual Random inspection. Family members residing in the home include 2 adults (licensee), spouse, and six minor children. All adults living in the home are not criminally background cleared (Licensee’s spouse). There was an 18 yr. old adult visiting the home (Licensee’s son) that was not criminally cleared. The home is licensed for fourteen (14) children. There are two (2) assistants present. LPA observed eight children: (5) toddlers and (3) infants’ children in active lesson and play and three (3) staff.
Physical Plant: This is a two story 4 bedroom, 3- bathroom home with kitchen, dining, family room, living room, and garage. Childcare is provided in downstairs Master Bedroom (on the right down the hallway upon entry). Child Bathroom is in hallway (right) next to daycare area. (No hazards). Age-appropriate toys and books. Unused outlets covered. Napping (mats, cribs) equipment. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room locked), medicines (kitchen high cabinet). Kitchen hazardous items (sharp knives top of pantry) that can pose a danger to children. Fire/earthquake drills (current). Roster (current). The required fire extinguisher (2A10BC) is full/green. Smoke detectors and carbon monoxide detectors (operable). Fireplace (screened). Home has central AC and heat. Required postings were present on the wall. Unused outlets (covered). Stairs (gated).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037
VISIT DATE: 09/19/2023
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Landline phone and cell phone.
Off limit areas: include Bedrooms (#2, #3, #4) upstairs, Bathroom #2, Bathroom #3 (upstairs), hallway leading from daycare area (gated) laundry room(locked) garage (thru laundry room), kitchen. Outside areas (not identified) LPA recommended updated facility sketch.
Outside: The backyard is completely fenced. No pets observed. Play structure (anchored), age-appropriate toys and bikes. No pool/spa or body of water on the premises. Artificial grass and concrete for play, shaded area (observed). Shed (locked). AC unit (covered).
Other: Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any in the home. Required training and CPR/First Aid (not current). The First Aid kit (observed). LPA viewed staff and children’s file (missing information) and conducted a staff interview with the licensee. Transportation is provided (insurance verified). The following was discussed with the Licensee:
Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, updated. Safe Sleep regulations were discussed and provided. The role and responsibilities of being a mandated reporter. Licensee reminded that 100% supervision is always required to all children in care. If food is brought in, it is properly labeled. Licensee will check food expiration dates periodically. Licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037
VISIT DATE: 09/19/2023
NARRATIVE
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. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). Type A citation: Type A citation(s) shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of the report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee is advised visit www.shotsforschool.org for Immunization information.
--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640
--Family Child Care Providers (Disaster Planning information): --Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov-Child Care Videos: https://ccld.childcarevideos.org--Licensee advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037
VISIT DATE: 09/19/2023
NARRATIVE
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 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.

The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm for information and reporting Unusual Incident Reports on LIC 624B form. LPA provided consultation (Safe Sleep) during the inspection.

Per Title 22 Regulations, there are deficiencies cited during the inspection. See 809 D pages.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit, and Appeal Rights were provided to Brandi Crooms, Licensee at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/19/2023 12:54 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/19/2023 at 12:29 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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, record review the licensee did not comply with the section cited above in two adults (Licensee son and spouse) were not fingerprint cleared which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2023
Plan of Correction
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Licensee provided a written declaration they will provide proof of fingerprint clearance for both adults ASAP and provide proof to Licensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


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Document Has Been Signed on 09/19/2023 12:54 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/19/2023 at 12:29 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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee needs to reassess the home for safety hazards in areas that are accessible to children. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Licensee will provide a written declaration stating the home will be reassessed to correct safety hazards and provide to Licensing by POC date of 9/22/23
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in three out of three infants did not have infant logs which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Licensee will provide a written declaration stating Infant logs will be maintained for all infants even own children under twelve months and provide to Licensing by POC date of 9/22/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/19/2023 12:54 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/19/2023 at 12:29 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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in two out of two staff did not have current CPR available at the time of inspection. Which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Licensee will provide proof of training to LIcensing by POC date of 9/22/23.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in thee out three staff did not have proof of immuniztions in staff files during inspection whicch poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Licensee will provide proof of immuniztions to Licensing by POC date of 9/29/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 09/19/2023 12:54 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/19/2023 at 12:29 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: CROOMS FAMILY CHILD CARE
FACILITY NUMBER: 367700037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, the licensee did not comply with the section cited above in three out of six children C2, C3, C5 did not have proof of immunizations inside the children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Licensee will provide proof of child's immunizations to Licensing by POC date of 9/29/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


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