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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700331
Report Date: 05/10/2023
Date Signed: 05/10/2023 02:33:37 PM

Document Has Been Signed on 05/10/2023 02:33 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:CORNEJO FAMILY CHILD CAREFACILITY NUMBER:
367700331
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Alba Cornejo, LicenseeTIME COMPLETED:
02:30 PM
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On May 10, 2023, Licensing Program Analyst (LPA), Kuliema Calloway met with Applicant(s) for the purpose of conducting a Pre-Licensing Inspection. Applicant(s) are requesting to provide care and supervision for a Small/Large Family Child Care Home for the capacity of 8 children. Currently residing in the home is applicant, their spouse, and six (6) children. All adults residing in the home have a Criminal Record Clearance (DOJ/FBI and Child Abuse Index Clearance. Applicant and LPA toured the home indoors and outdoors to ensure the home meets licensing requirements. Applicant is requesting the days and hours of operation will be: 6:00 Am to 6:00 PM. Monday through Friday for the Family Child Care. Per applicant, no overnight care will not be provided.
The Home is set up as follows:
Physical Plant: This is a single-story home with three (3) bedrooms and two (2) bathrooms, a kitchen, living room, dining room, and garage. The home is inspected for safety, comfort, cleanliness, telephone service, and proper ventilation. There is no landline phone but a cell phone. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris. The fireplace was observed in the living room and is covered with shelving in front. The kitchen was inspected there were no hazardous or dangerous items. All the sharp utensils and knives were stored inside the kitchen cabinet to the left of the stove up high. The refrigerator/ freezer was inspected, and both were clean and in good repair. Dining/seating for at least six children were counted. Detergents/cleaning compounds are kept in the off-limits Garage. Medications are stored in the locked hallway closet. The hot water was tested at a safe temperature between 105-120 degrees.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 367700331
VISIT DATE: 05/10/2023
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Childcare Area: Per Applicant, the living room will be utilized for the Family Child Care (upon entry). LPA observed age-appropriate furniture for the children that is in good repair. There are toys and books on the premises of this facility. LPA observed appropriate napping equipment. There is a locked hallway closet in the childcare area for storage and supplies. All unused electrical outlets are covered. The isolation area is a small child sofa near the dining area until the parent can pick up the child. The First Aid Kit was observed complete with supplies and a first aid manual. Transportation will be provided. The blinds are cordless.
Child Bathroom #1 The Bathroom (in the hallway on the left) was toured and inspected the sink/toilet are operable. There were no shampoos, mouthwash, razors, poisons, or medications. The cabinets and drawers were locked with a magnetic lock. The bathroom was clean, sanitized, and in good repair.
Outside: The backyard was inspected. The backyard is fenced all around. There is grass and concreted area for active play. There is a swing and slide set that is anchored to the ground. There is a play structure anchored to the ground (ladder redirected). There are age-appropriate toys and bikes for play. LPA observed a small pet dog in the backyard (gated, separate area). The dog is vaccinated and per applicant, will not interact with the day care children. The AC/Heating Unit is on the right side of the home in the front yard. LPA suggested a lock for the outside gate and a covering for the gapped opening.
Off Limit Areas: Bedroom #1, Bedroom #2, Bedroom #3, Kitchen, Garage. LPA observed key locks on door to Bedroom #3 and safety locks on Bedroom #1 and Bedroom #2.
Others:
LPA observed current Pediatric CPR/First Aid, Preventive Health and Safety Training, Mandated Reporter, and Immunizations. Postings: Emergency Disaster Plan, Earthquake Preparedness Checklist, and Notification of Parent's Rights.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 367700331
VISIT DATE: 05/10/2023
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The Safe Sleeping Regulation was shared with the licensee. The fire extinguisher that is FULL/Green and kept inside the kitchen. It meets standards established by the State Fire Marshall. The smoke detectors and carbon monoxide detectors were tested and are operable. Per applicant, there are no weapons or firearms in the facility. LPA did not observe any firearms or weapons. Incidental Medical Services (IMS) policy was discussed.
The following information was discussed with the licensee:
Maintain mandatory forms for the children’s files and provider’s files. Requirements for fire drills, earthquake drills, and documentation for both. The licensee is reminded that 100% supervision is always required for all children. Capacity limits, parent/child roster maintenance, posting facility license, knowledge of Emergency Plan, and documenting Disaster Drills (Fire and Earthquake). All food is properly labeled if brought from child’s home; and all food is checked periodically for expiration dates. Applicant was advised how to access forms and Regulations for Family Child Care online at: www.ccld.ca.gov. Applicant was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.. A licensed childcare provider, administrator, or employee of the licensed child day care facility shall complete an on-line Mandated Reporter Training and shall renew the training every two (2) year at: www.mandatedreporter.com. 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 (LIC 624B). The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also, call the CCLD office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Criminal Record Statement: 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
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 367700331
VISIT DATE: 05/10/2023
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existing clearance or exemption, prior to the 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. Safe Sleep: 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. Notice of Site Visit: A notice of site visit must remain posted for 30 days. Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Parent Notifications Requirements: Per the Health and Safety code (HSC) 1596.859, 1596.8895, and 1597.05 to improve transparency of licensing records and to ensure that the parents/guardians using the licensed childcare facility are aware of situations that present danger to the children. Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against Influenza, Pertussis, Rubella, Mumps, and Measles. Each employee and volunteer shall receive an Influenza vaccination between August 1 and December 1 of each year. Type A citation: Type A citation(s) shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 367700331
VISIT DATE: 05/10/2023
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A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exer-saucers, and any other items that fall into that category. Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
The On Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM. A copy of the Safe Sleep Proposed Regulations was provided to Licensee. **Incidental Medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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.htmSafe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 367700331
VISIT DATE: 05/10/2023
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Applicant advised visit www.shotsforschool.org for Immunization information.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

Prior to being licensed, the following corrections are required by: June 10, 2023



· Current LIC 279B listing all children that live inside the home.
· Play structure ladder needs to be removed and placed in a different area.
· LPA recommended a lock for the outside gate leading to the field behind the home.
· Remove the safety latch from children’s bathroom.
· Proof of vehicle registration and car insurance for transportation vehicle.

As a result of this inspection, corrections are needed before a Child Care License can be issued.

Exit interview conducted: A copy of this report, Notice of Site Visit were discussed and left with Alba Cornejo, Applicant

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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