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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700220
Report Date: 07/20/2023
Date Signed: 07/20/2023 01:23:19 PM

Document Has Been Signed on 07/20/2023 01:23 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:GONCALVEZ DE BROWN FAMILY CHILD CAREFACILITY NUMBER:
367700220
ADMINISTRATOR:ANA GONCALVEZ DE BROWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 475-7680
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
07/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ana Goncalvez De BrownTIME COMPLETED:
01:45 PM
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On 7.20.23, Licensing Program Analyst (LPA) Kris Diaz met with the Licensee, Ana Goncalvez De Brown for an unannounced annual/random inspection. The licensee is also requesting to make an off-limits room accessible. The licensee gave the LPA access to the home and guided a tour of the facility. People who reside in the home are the licensee and her adult daughter, who has fingerprint clearance. The licensee has the required immunizations against pertussis (TDAP), measles (MMR) and has a signed statement declining the flu vaccine on file. At the time of the visit LPA observed 5 child care children and licensee’s minor son who volunteers at the facility. LPA reminded licensee that 100% supervision is required at all times and minor son cannot be left alone with the children. Per the licensee, the large family childcare home operates 7:30am – 5:00pm Mon-Fri. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS currently.

This is a single story house with 4 bedrooms, 3 bathrooms including a great room that includes the kitchen, dining area, family/daycare room, laundry room and attached garage. Main childcare family room/kitchen, 1 bathroom (down hallway near playroom) and bedroom (playroom) are utilized for child care. Children have access to the backyard. LPA observed play structures and several age-appropriate toys, books, and activities in the child care areas. Per licensee, off-limit areas of the home are the 3 bedrooms, master bathroom, laundry room, and garage. The licensee is approved to use the 2nd bedroom for childcare effective 7/1/2023.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds (kept in the laundry room which is key-locked), medicines (upper kitchen cabinet inaccessible to children), and hazardous items that can pose a danger to children. Sharp knives are kept in an upper kitchen cabinet inaccessible to children. The facility roster is complete and maintained current. Fire/earthquake drills are also current. The licensee has pet rabbits in an enclosure in the great room and a dog that is kept behind a separate gate in the backyard. Both are inaccessible to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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: GONCALVEZ DE BROWN FAMILY CHILD CARE
FACILITY NUMBER: 367700220
VISIT DATE: 07/20/2023
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Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. Children nap in the living room area. Mats and blankets are provided for napping. The required fire extinguisher (2A10BC), smoke detector and carbon monoxide detector are in operable condition. Home has central AC and heat. Licensee's Pediatric CPR/First Aid expires 08/2024. The licensee has first aid kits in the playroom and daycare areas kept inaccessible to children. LPA observed the parent board and required documents are posted. The licensee was reminded that Mandated Reporter Training for childcare must be completed by licensees and any adults assisting in the childcare home every 2 years.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; 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 child care home and in those areas of the family child care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.

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. 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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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: GONCALVEZ DE BROWN FAMILY CHILD CARE
FACILITY NUMBER: 367700220
VISIT DATE: 07/20/2023
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Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. Handout of Safe Sleep Concepts was given to the licensee.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

Exit interview was conducted, report was read with and provided to Licensee on this date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC809 (FAS) - (06/04)
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