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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700498
Report Date: 12/11/2025
Date Signed: 12/11/2025 12:28:18 PM

Document Has Been Signed on 12/11/2025 12:28 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:PATRICK FAMILY CHILD CAREFACILITY NUMBER:
367700498
ADMINISTRATOR/
DIRECTOR:		KASSIE PATRICKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 414-6986
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/11/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Kassie Patrick - ApplicantTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On Thursday December 11, 2025, at 9:20AM, Licensing Program Analyst (LPA), Giovanni met with applicant Kassie Patrick for the purpose of conducting a Pre-Licensing Inspection. Applicant and LPA toured the home, indoors, and outdoors to ensure the home meets Title 22 licensing requirements. The applicant is requesting to provide care and supervision for a Small Family childcare home for a capacity of six (6) to eight (8) children. Currently residing in the home are the following, one (1) adult; applicant, and three (3) minor children. All adults residing in the home have a Criminal Record Clearance (DOJ/FBI) and Child Abuse Index Clearance and are associated with the home. The applicant is requesting the following days and hours of operation: 8:00 AM to 7:00 PM, Monday through Saturday, for ages 2-18 yrs. Per applicant overnight care will not be provided at this time.

The Home is set up as follows:

Physical Plant: This is a two-story home with four (4) bedrooms (all toured) and two and a half (2.5) bathrooms, a kitchen, living/dining room, family room, loft, laundry room, garage, front and backyard. The home was inspected for safety, comfort, cleanliness, telephone service and proper ventilation. There is no landline phone but there is 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 is screened and made inaccessible with glass doors.

Childcare Area: Per Applicant, living/dining room, will be utilized for Family Childcare, and bathroom #1 (1/2). LPA observed age-appropriate furniture, toys, and books for the children. The napping equipment consists of eight (8) cots (Licensee needs to built cots and make available). There are enough for all children. All unused electrical outlets are currently not covered. (Licensee will provided proof).

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2025
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.

LIC809 (FAS) - (09/23)
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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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 367700498
VISIT DATE: 12/11/2025
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The isolation area is in the family room until the parent can pick up the child. Blinds cords are tied high and made inaccessible. LPA observed one dining table which seats six (6).

Off Limit Areas: All upstairs Bedrooms #1-#4, Bathrooms #2-#3, (will made inaccessible with a barrier gate at the bottom of the stairway, licensee will provide pictures), kitchen (made inaccessible with barrier gates on both sides of the kitchen, licensee will provide pictures), garage (made inaccessible with key locks), and backyard area (made inaccessible with latch on sliding door).

Kitchen: The kitchen was inspected and there were no hazardous or dangerous items. All the sharp knives, sharp utensils (made inaccessible inside the pantry with key lock), detergents, cleaning compounds, and medications are in off-limit upstairs. The refrigerator and stove are both working.

Child Bathroom (1/2): The Bathroom is in the hallway on the left, which was toured and inspected. The bathroom was clean, sanitized, and in good repair. The sink and toilet are both operable. There were no cleaning supplies, shampoos, bodywash, razors which can post a danger to children. There is no cabinet or drawers underneath bathroom sink.

Outside: The backyard was toured and inspected. The backyard is fenced all around with wood fencing. The yard is composed of dirt and gravel. LPA observed one (1) A.C. unit with a metal barrier over the fan blades for protection. Per applicant there are no pools, spas, or bodies of water on the premises. LPA did not observe any pool, spas, or bodies of water on the premises. Per applicant, there is one small dog (poodle) as a pet. LPA observed the dog to be in the off-limit backyard. Per applicant the dogs is vaccinated and will not interact with the day care children.

Others: LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was also provided to the applicant.

Current Pediatric CPR/First Aid, Preventive Health and Safety Training, Mandated Reporter, and Immunizations were viewed as complete inside the application. The Safe Sleeping Regulation was shared with the Applicant. There is one (1) small fire extinguisher which does not meet licensing regulations. Licensee was made aware that Fire extinguisher needs to be (2A10BC or larger). Licensee will provide proof when purchased.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 367700498
VISIT DATE: 12/11/2025
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The smoke detectors and carbon monoxide detectors were tested, and only the smoke detector was operable. Licensee will replace the batteries on the carbon monoxide detector and provide proof. Per applicant, there are no weapons or firearms in the home. LPA did not observe any firearms or weapons inside the home. The First Aid Kit was observed to be incomplete. Licensee will purchase a new First Aid Kit and provide proof. Incidental Medical Services (IMS) policy was discussed. Transportation will not be provided at this time. The applicant provided proof of control of property. Per applicant, there is no day care liability insurance.

The following information was discussed with the Applicant:

Temporary absences should not exceed 20 percent of the hours while the facility is providing care per day. If day care is closed for the day, or Licensee is absent, the applicant must notify Licensing. Maintain mandatory forms for the children’s files, provider’s files, and employee files. Requirements for disaster drills (fire and earthquake) and documentation for both. The applicant is reminded that supervision is always required for all children. Maintain capacity limits, parent/child roster maintenance for three years with complete information, posting facility license, knowledge of Emergency Plan. 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 Childcare 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. Applicant 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) years at: www.mandatedreporterca.com. Applicant was advised of the importance and 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) and send via email to: www.unusualincidentreport@dss.ca.gov. or via fax. The applicant was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000 and call the CCLD (Community Care Licensing Division) office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 367700498
VISIT DATE: 12/11/2025
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Criminal Record Statement: Applicant, was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. Safe Sleep: LPA discussed the safe sleep regulations with applicant and discussed the Child-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. 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, 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.

Applicant shall provide a copy of 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 violation. 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

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 367700498
VISIT DATE: 12/11/2025
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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. Applicant 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, which are also available 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. Childcare Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

On this date, 7/22/2025, the California Attorney General - Megan’s Law website was verified for information on sex offenders which required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address.

Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

The On Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM for questions, information, and Unusual Incident Reporting.

A copy of the Safe Sleep Proposed Regulations was provided to the Applicant.

*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 Childcare 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 Childcare Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Safe Sleep in Childcare: 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.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 367700498
VISIT DATE: 12/11/2025
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Applicant advised visit www.shotsforschool.org for Immunization information.

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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/.

Subscribe and select the Childcare option to receive email communication.

There are several corrections needed before a childcare license can be issued.

· Correct Fire Extinguisher (2A10BC or Larger, Provide picture)

· Make Stairway and Kitchen inaccessible with barriers (Provide Picture)

· Cover all unused electrical outlets (Provide picture)

· Replace batteries on Carbon Monoxide detector (Provide Video)

· Make Childcare area presentable (Send Picture)

· Built cots and make ready for napping (Provide Picture)

Exit interview conducted this report was read, a Notice of Site Visit, and this report was given to the applicant Kassie Patrick, and must remain posted on, or immediately adjacent to, the interior side of the main door for thirty (30) days.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
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