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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700392
Report Date: 02/07/2024
Date Signed: 02/07/2024 11:53:42 AM

Document Has Been Signed on 02/07/2024 11:53 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:NAVARRETE FAMILY CHILD CAREFACILITY NUMBER:
367700392
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/07/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jessica Navarrete, Applicant TIME COMPLETED:
12:30 PM
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On 02/07/2024, Licensing Program Analyst (LPA) Justeene Tamayo conducted a Pre-licensing Inspection with Applicant Jessica Navarrete, who guided LPA on a tour of the facility.

This is a one story house with 4 bedrooms, 2 bathrooms, living room, kitchen, dining room area, laundry room and garage. Family members residing in the home include 2 adults (Applicant and applicants spouse) and 3 minor children.

The facility will operate Monday through Friday 6AM-6PM and with a license capacity of 8 children. LPA went over the child care ratios for a small family home with applicant, and provided applicant with a copy.

Main care will be provided in the living room area. Children will eat in the dining room area. Per applicant, she plans on having a food program. The day care children will utilize the hallway bathroom on the right hand side. The front yard, all bedrooms (safety door knob and key lock), bathroom #2, laundry room (key locked), and garage area(key locked) are off limits to the day care children.

There are no pools or bodies of water on the premises.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 367700392
VISIT DATE: 02/07/2024
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LPA observed day care area to be clean and orderly, central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector.

LPA observed a clean, safe and operable toilet and faucet. LPA reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover.

LPA observe a fully charge 2A10BC fire extinguisher during the inspection located in the ktichen area. LPA observed the first aid kit stored in the kitchen area.

Applicant made poisons and cleaning items inaccessible to children store. Medications are stored in the master bedroom(key locked). Cleaning supplies are located in the laundry room (key lock), as well as under the kitchen sink (with magnet lock).

Kitchen: LPA observed the kitchen area to be free of hazards. The following are inaccessible: Sharp items are stored in upper kitchen cabinet unreachable to children in care. LPA observed the refrigerator and freezer to be clean. LPA discuss with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent. Applicant plans on providing breakfast,lunch, and snacks to the day care children.

LPA toured the backyard and observed it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. LPA observed an outdoor air conditioner covered with a mesh covering. Applicant is aware barbecue pits or fire pits must be made inaccessible to day care children. The backyard is completely barricaded with wooden fencing and block cement. LPA observed a storage den with key lock. LPA also observed a dog run in the backyard. Applicant has three dogs on the premises. LPA obtained a copy of three dogs vaccination record. Backyard is observed to be safe for day care children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 367700392
VISIT DATE: 02/07/2024
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LPA discussed the safe sleep regulations with applicants, including Safe Sleep PIN 20-24-CCP 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 applicant 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.

Applicant informed smoking is prohibited, applicants stated no one smokes in the home, LPA discussed Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicants with a visual copy of prohibited items. LPA did not observe prohibited items during the inspection. Per applicant, no firearms are present in the home. Applicant was informed their cell phone shall be available and charged at all times during daycare hours.

Incidental Medical Services (IMS) policy was discussed, informing applicant when any IMS is provided, a plan for providing IMS must be submitted to the Department prior to providing care to a child that need IMS. The plan shall state the type of IMS the facility will be offering, stating the person providing care has been trained to provide the named IMS. The plan will also provide the steps that will be taken when IMS is provided to a child.

The following information regarding ADA was discuss and the following information 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

Applicant is ready for licensure.

Exit interview conducted copy of this report was provided to applicant Jessica Navarrete, along with her notice of site visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 367700392
VISIT DATE: 02/07/2024
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Applicant 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.

Documents Provided and or Discussed: The following were provided to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), Safe Sleep Log, water lead poster, required postings and list of CCLD forms required for child file each child in care (LIC 311D). Applicant stated currently does not have childcare insurance. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident to the department. Applicants were informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

Advisory/Other: LPA observed a first Aid kit with emergency supplies and a thermometer in the kitchen area. Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Mandated Reporter training can be renewed every 2 years at www.mandatedreporterca.com. Electrical outlets are inaccessible to children. Children will nap on cots in the living room area. Applicant aware no infant shall be swaddled, and car seat shall not be used for sleeping. Applicant is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the infant’s status. Applicant should refer to regulation 102425(J) for documentation requirement. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC809 (FAS) - (06/04)
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