367700046-2-4-2025-12-CC-JTAO-DDKUKB-20250204143853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700046
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:48:50 PM

Document Has Been Signed on 02/04/2025 02:48 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:	JENSEN FAMILY CHILD CARE		FACILITY NUMBER:	367700046
ADMINISTRATOR/ DIRECTOR:	JENSEN, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 963-6114
CITY:	BARSTOW	STATE: CA	ZIP CODE:	92311
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	02/04/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:22 PM
MET WITH:	Maria Jensen, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:03 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/04/2025, Licensing Program Analysts (LPAs) Justeene Tamayo and Hanna Cha conducted an unannounced annual inspection. The LPAs disclosed the purpose of the inspection and was permitted entry by licensee. The Licensee guided the LPA on a tour of the home. Upon entry to the facility, the LPAs observed 2 infants and 7 preschool children in care and Assistants #1-2 providing care and supervision. Adults residing in the home include 2 adults (licensee and licensee's adult daughter) and 2 minor children. The operational childcare hours are Monday through Sunday and varies up to 23 hours for parent’s needs. This is a one-story family home. There is a living room, kitchen, three bedrooms, two bathrooms, laundry area, and a converted garage but is not accessible to the children in care. The Licensee does provide napping, there are fourteen cots and four playpens. The off-limits areas are the two bedrooms, second bathroom, laundry area, and converted garage. Licensee provides breakfast, lunch, dinner, and snacks. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds(in converted garage with half-door barricading area), and hazardous items(knives located in kitchen drawer) that can pose a danger to children. Medications are stored in the upper kitchen cabinet unreachable to day care children. The kitchen is fully barricaded by 1 half door near the front entrance and another safety gate barricading the main care area. Hanging window blind cords: There are no cords on the window blinds. Pets: there are no pets on premises. Phone service: There is a working cell phone, charged and kept on Licensee at all times. Transportation: The Licensee does provide transportation for children, they are aware that they must have a valid driver license, the vehicle has to be insured, and registered. Isolation occurs in the first bedroom on the right in the hallway that is part of the on-limits area for children in care showing signs of illness. Calming occurs in the corner of the living room. Continue to next page

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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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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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 367700046
	VISIT DATE: 02/04/2025

NARRATIVE

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There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. LPAs observed rubber matting for the outdoor play equipment. Both sides of the home are closed by fencing and remain off limits. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, adhesive tape, and cleansing pads/solution was observed to be complete and inaccessible to children kept in a hallway cabinet secured with a safety knob. The required fire extinguisher (2A10BC) is reading in green. Smoke and carbon monoxide detectors were found to be in operable condition, tested at 12:50PM and 12:52PM, respectively. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 11/22/2024.

Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), and Emergency Disaster Plan (LIC 610A).

Licensee's First Aid CPR expires on 01/02/2027. Child Care Provider Mandated Reporter Training Certificate has been completed and valid until 02/25/2026. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Training, background clearances, and Pediatric First Aid & CPR.

During file review assistant #1 did not have a fingerprint clearance. LPAs observed assistant #1 leave the premises and a Type A Citation will be cited. A civil penalty of $100 has been assessed. Please see LIC809-D for deficiency page.

Due to a Type A citation being cited today, licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 367700046
	VISIT DATE: 02/04/2025

NARRATIVE

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Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.

Facility Representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Licensee was reminded to report Unusual Incidents. 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. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPAs discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource.

An exit interview was conducted, and a copy of this report was read and provided to licensee on this date, as well as a copy of her appeal right and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 367700046
	VISIT DATE: 02/04/2025

NARRATIVE

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LPAs also informed the Facility Representative 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.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-

CCP. 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/.

Facility Representative 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, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and the RSO profile has been completed in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541.
The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/04/2025 02:48 PM - It Cannot Be Edited

Created By: Justeene Tamayo On 02/04/2025 at 02:16 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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 367700046
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/04/2025

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
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above. LPAs observed assistant #1 providing care and supervision without proof of criminal record clearance,which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/05/2025
	Plan of Correction
1 2 3 4	Licensee will have assistant #1 re-fingerprinted and will not allow assistant #1 back on the premises until fingerprints are cleared.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 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:

Mariela Ramon

LICENSING EVALUATOR NAME:

Justeene Tamayo

LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC809 (FAS) - (06/04)

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