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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700312
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:57:46 AM

Document Has Been Signed on 11/30/2023 11:57 AM - 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
367700312
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Mirna RodriguezTIME COMPLETED:
11:57 AM
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On November 30, 2023, Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced case management inspection at the Rodriguez Family Childcare Home. LPA met with Licensee, Mirna Rodriguez for the purpose of a capacity increase inspection. Licensee grant access to the home and guided LPA on a tour. Licensee resides in the home with her mother and brother who all have fingerprint clearance and TB test. At the time of arrival there were 5 children (2-5 yo) present with Licensee and Assistant, Martha Miramontes. Hours of operation are Monday through Friday 7am-5pm. Incidental Medical Services were discussed. Per licensee, at this time there are no children in care that require IMS.

This is a one story home with 4 bedrooms, 3 bathrooms, a kitchen, dining area, living room, laundry room, backyard and garage. There is no pool/or body of water on the premises. Accessible areas of the home include the day care room, restroom inside day care room and side yard play area separated from backyard. Inaccessible areas are made inaccessible with gates and safety doorknobs. Per licensee, children are escorted to side yard play area through the living room. LPA observed several age appropriate toys, games, and activities in the day care room and outside play area. Per licensee, 100% visual supervision is provided to children in care.

LPA observed smoke detector, carbon monoxide detector, emergency fire pull, and fire extinguisher (2A10BC) all in good repair and operable condition. LPA reviewed 5 children's files and 2 provider's files all complete with required documents. LPA observed all required documents posted in day care room on parent board. LPA provided licensee a copy of LIC 9148 - Earthquake Preparedness Checklist to post. Pediatric First Aid/CPR and mandated reporter training are current.

LPA reminded licensee that single-action door handle is required and must be replaced prior to capacity increase approval. Per licensee, she can complete this correction by this weekend. LPA is extending POC due date to 12.8.23. LPA advised licensee to provide photo proof of correction prior to capacity change approval.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 367700312
VISIT DATE: 11/30/2023
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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.

Prior to capacity increase approval the following corrections are required by: Friday, December 8, 2023

ยท Place single-action handle on exit door in day care room.

See https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2023/CCP/PIN-23-11-CCP.pdf

This inspection was conducted in person. The report was read with the applicant. A copy of this report and the Notice of Site Visit was provided to applicant, Mirna Rodriguez. Exit interview was conducted

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

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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