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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700045
Report Date: 04/26/2022
Date Signed: 04/26/2022 02:50:26 PM

Document Has Been Signed on 04/26/2022 02:50 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:HANEY FAMILY CHILD CAREFACILITY NUMBER:
367700045
ADMINISTRATOR:HANEY, CASSANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 910-3573
CITY:TWENTYNINE PALMSSTATE: CAZIP CODE:
92277
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Licensee Cassandra Haney TIME COMPLETED:
03:00 PM
NARRATIVE
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On April 26, 2022 License Program Analyst (LPA) Kendal Zirbes conducted an unannounced case management inspection to the family child care home. The purpose of the unannounced inspection was to follow up on a matter unrelated to this inspection. LPA announced the reason for the unannounced inspection and the Licensee granted LPA access to the home.

LPA Zirbes arrived at the family child care home at 10:30am. LPA observed the Licensee alone and providing supervision to nine child care children. Of the nine children, there was one infant, two school age children and six preschool age children in care. At approximately 10:41am, adult 1 (A1) arrived to the facility with two additional child care children.
Based on LPAs observation, the facility was out of ratio when LPA arrived to the home and observed the licensee caring for a total of nine children. This family child care home is licensed for a capacity of 14 children and is able to provide care to 14 children only when specific criteria is met. Per regulation, 102416.5 (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. A small family day care home may provide care for more than six and up to eight children, without an additional adult attendant. Based on LPA observation, the facility was out of ratio when the Licensee was providing care to nine children. This poses an immediate Health, Safety or personal right risk to the children in care. The facility is being cited for a type A citation. Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.
Report continued on page two
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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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Document Has Been Signed on 04/26/2022 02:50 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 04/26/2022 at 01:11 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: HANEY FAMILY CHILD CARE
FACILITY NUMBER: 367700045

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2022
Section Cited
CCR
102416.5(e)

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102416.5 (e) Staffing Ratio and Capacity: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced by:
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Per Licensee the capacity and ratio regulations will be reviewed along with capacity and ratio videos. Licensee will provide documentation that the videos have been reviewed and provided CCL with a declaration by 4.27.22, Licensee will find an additional staff person to assist when required.
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Based on LPA observation, the License was providing care to nine children which exceeds the staffing ratio and capacity for a small family child care home. This poses an immediate Health, Safety or personal right risk to the 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.
SUPERVISOR'S NAME:Carissa Bell
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022


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: HANEY FAMILY CHILD CARE
FACILITY NUMBER: 367700045
VISIT DATE: 04/26/2022
NARRATIVE
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Report continued from page one

Further more, the facility is being providing with a technical advisory notice for regulation 102370 (d) (2) Criminal Record Clearance. Per licensees statements A1 is a licensed provider in the area with a eligible background clearance. Licensee stated that A1 has not provided care and supervision to the children enrolled in the Licensees child care. LPA advised the Licensee that A1 should be associated to the facility.

During this inspection, LPA provided the Licensee with information regarding the capacity and ratio requirements of a small and large family child care home. The Licensee was advised to visit the following website to access informational videos regarding licensed child care regulation.
https://ccld.childcarevideos.org/family-child-care-providers/

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Cassandra Haney.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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