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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700045
Report Date: 11/29/2022
Date Signed: 11/29/2022 02:35:40 PM

Document Has Been Signed on 11/29/2022 02:35 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: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: 6CENSUS: 4DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Licensee Cassandra HaneyTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee, Cassandra Haney who guided analyst on a tour of the facility for the One Year Required inspection. This is an single story house with three bedrooms, two bathrooms, kitchen, dining room, living room, daycare room, attached garage, and backyard. Per Licensee the daycare room, living room, dining room, kitchen, backyard and one bathroom are utilized for childcare activities. The off-limits areas consists of the three bedrooms, bathroom within the master bedroom, and the garage. These areas have been made inaccessible via the use of door locks. Upon arrival, LPA observed four children in care (two infants and two preschool children) with the Licensee providing supervision. Currently living in the home are the Licensee, and two minor children (8, 10). All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 6:30am -5:00pm.

Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. According to Licensee all cleaning products are stored in the cabinet under the kitchen sink and on a high inaccessible shelf above the washer/dryer. Sharp knives are stored on top of the kitchen cabinets in an inaccessible location. According to the Licensee all household medications were stored in the off limits primary bedroom. Per recorded documentation Fire/earthquake drills were completed 2022, the fire extinguisher was serviced in July 2022.

Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The daycare room is the designated area for ill children in the child care.
Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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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: HANEY FAMILY CHILD CARE
FACILITY NUMBER: 367700045
VISIT DATE: 11/29/2022
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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home has a fireplace with a glass fire place screen that is equipped with a child safety latch. The home has window blinds in the living room. LPA and Licensee discussed infant safe sleep and the potential danger of the inner cords.

Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.
During the walk through LPA observed the child safety latch on the front loading dryer was broken and hygiene products were stored in a low hallway cabinet. The hygiene products and the dryer were inaccessible to the children in care via a child safety gate at the time of the inspection. However, LPA advised the Licensee to install a child safety lock on the cabinet or move the products to a inaccessible area of the home. LPA advised the Licensee to purchase a new latch for the front loading dryer.

Outdoor: The backyard had a covered patio and additional areas for the children to engage in gross motor activities. The Licensee had child size bikes, a little tikes slide and additional materials for the children. LPA observed four nails with sharp points protruding through the wooden fence. In addition, LPA observed yard tools on the side of the home. LPA advised the Licensee to remove the nails and yard tools from the area. Furthermore LPA advised the Licensee to obtain a cover for the air conditioner unit on the side of the home. A technical advisory notice was provided. LPA reminded the Licensee to regularly monitor the play area for potential hazards.

Per Licensee, the family has zero pets. However occasionally the Licensee takes care of a family members dog. LPA advised the Licensee to ensure all pets were up to date on shots.

CPR/First Aid expires 11/15/2024 and mandated reporter training expires on 1/14/24.



Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.
LPA reviewed six child files and the Licensees. Based on LPAs record review the staff and child files were complete and included all required information.
Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep.
Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: HANEY FAMILY CHILD CARE
FACILITY NUMBER: 367700045
VISIT DATE: 11/29/2022
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Report continued from page two
The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified



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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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.

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.

Based on LPAs record review there were zero citations issued today however an technical advisory notice was issued.

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: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4