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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700136
Report Date: 01/28/2026
Date Signed: 01/28/2026 12:52:19 PM

Document Has Been Signed on 01/28/2026 12:52 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
367700136
ADMINISTRATOR/
DIRECTOR:		DAVIS, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 949-1580
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Tiffany Davis, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On January 28, 2026, Licensing Program Analyst (LPA) Annelise Villa met with Licensees Tiffany Davis who guided analyst on a tour of the facility for the random annual inspection. Upon arrival, LPA observed 0 children in care. Family members living in the home are Licensees and 1 minor child. Hours of operation 23 hours a day, Monday through Sunday. Incidental Medical Services (IMS) policy was discussed. No children in the day care with IMS.

Physical Plant: This is a single story 5-bedroom, 2-bathroom home with kitchen/dining, family room, laundry room and garage. No day care activities are held in the garage. Garage was observed to be locked at the time of inspection. Accessible areas of the home are family room, bathroom #1, and back yard. Off limit areas are bedrooms #1-5, bathroom #2, kitchen, laundry area, garage, and front yard. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, and medicines. Hazardous items (sharp knives located in the off limits kitchen, cleaning chemicals are stored underneath the kitchen, and medications are stored in the kitchen in an upper kitchen cabinet) are inaccessible to children in care.

Safe and age-appropriate toys, play equipment and materials were observed. LPA tested the smoke detector and carbon monoxide detector and observed both to be in operable condition. Fire extinguisher (2A10BC) was observed in operable condition in the kitchen. Electrical outlets were inaccessible. No recalled and/or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2026
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.

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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 367700136
VISIT DATE: 01/28/2026
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Bathroom: Children’s bathroom #1 is located in the hallway. Bathroom #1 was observed to be free of hazardous materials or objects. LPA reminded applicant the children's bathroom must be free of accessible shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPA observed a clean, safe and operable toilet and faucet.

Kitchen: The kitchen was observed to be clean and orderly. Hazardous items were observed to be properly stored and inaccessible to children in care. LPA observed the refrigerator and freezer to be clean and fully stocked. LPA discussed with advised food shall be properly stored or refrigerated in containers that are labeled with child’s name when supplied by parent. At this time, Licensee is not a participant in a food program.

Outdoor: Children use the back yard for outdoor play. The play area is completely fenced all the way around. The front yard is off limits to children in care. LPA observed the back yard to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. Facility is advised all outdoor play shall be supervised at all times.

Advisory/Other: First Aid kit was observed with supplies readily available in the living room. Licensee’s First Aid/CPR is expired as of 6/2025. This is a Type B citation. Licensee shall send proof of completion no later than 2/27/2026. Licensee’s Mandated Reporter training are expired as of 7/31/2025. This is a technical violation. LPA reminded licensee mandated reporter training and First Aid/CPR must be completed every 2 years. Licensee was advised online First Aid/CPR courses cannot be accepted and all in person courses must be EMSA approved. For more information about First Aid/CPR courses, please visit, https://emsa.ca.gov/childcare_provider/. Per Licensee there are no pets in the home. Licensee stated is 1 firearm in the home. Additionally, Licensee stated there is no smoking of any kind in the home. Last fire/disaster drill was conducted on

Pools/Spas/Bodies of Water: There is a swimming pool and spa combination in the backyard. There is a 5 foot metal fence separating the accessible areas of the children’s play area from the pool area. The bodies of water are completely enclosed by a 5 ft metal fence. The fence runs all the way down to the concrete on which it sits, leaving minimal room between the bottom of the fence and the concrete. The pool gate was observed to have a locking mechanism. The gate has a locking mechanism and it is located within 6 inches from the top of the gate. The lever to open the gate is located at the top of the gate. The pool gate opens away from the body of water. All items rendering the fence climbable are moved away from the fence. The metal fencing is sturdy and capable of withstanding the impact of children's toys including bicycles.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 367700136
VISIT DATE: 01/28/2026
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LPA discussed the following AB 2866 pool safety regulations with Licensee:

1. An access gate that opens away from the pool and is self-closing with a self-latching, lockable device that is no lower than 60 inches above the ground.
2. The enclosure must be at least 60 inches tall and the vertical clearance from the bottom of the enclosure to the ground must be no more than 2 inches.
3. No gaps in the enclosure that could allow for a sphere of 4 inches or larger to pass through.
4. The outside surface must be free of any physical characteristics that could be used as a handhold or
foothold for a child to climb over.
5. If mesh fencing is used and it does not meet the requirements above, the licensee must provide documentation that establishes the mesh fencing is compliant with the American Society for Testing and Materials (ASTM) International Standard F2286.

Licensee is required to obtain all of the below safety equipment visible from the pool and available for immediate use no later than 2/11/2026:

1. A life ring with a diameter of at least 17 inches with a United States Coast Guard approval label.
2. A rescue pole with a body hook that is at least 12 feet long but must be long enough to effectively rescue a Child at the facility’s pool. It must be a fixed length – and not an adjustable pole. Additional guidance will be forthcoming in written directives to specify this requirement so that the pole must be long enough for a rescue at the facility’s pool. A wider pool may require a longer rescue pole.
3. An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.
4.The licensee performs a daily inspection of all above safety features before children arrive for the day.
A log of the daily inspections must be maintained by the licensee and provided to the Department upon
request.

Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 367700136
VISIT DATE: 01/28/2026
NARRATIVE
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Licensee’s annual fees are current. LPA observed all required facility postings on premises. Licensee had the following required posted documents: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203) and Fire/Disaster Log. Licensee was reminded to post Emergency Disaster Plan (LIC 610A) in a prominent place.

Documents Provided and or Discussed: Earthquake Preparedness Checklist (LIC 9148), Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227).

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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov. 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.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed changes, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 367700136
VISIT DATE: 01/28/2026
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep. More information on Infant Safe Sleep procedures can be found online on the CDSS web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/. The Department will convey all new information through PINs. Please sign up to be notified here and visit the Department’s website for the latest PINs.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

Exit interview conducted, and report was reviewed with the licensee. A notice of site visit was given and must remain posted for 30 days. One citation was given as a result of the inspection.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Annelise Villa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/28/2026 12:52 PM - It Cannot Be Edited


Created By: Annelise Villa On 01/28/2026 at 12:20 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: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 367700136

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2026

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 [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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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.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Annelise Villa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2026


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