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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413846
Report Date: 12/01/2022
Date Signed: 04/04/2023 05:58:08 PM

Document Has Been Signed on 04/04/2023 05:58 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:BARBOSA MANRIQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197413846
ADMINISTRATOR:BARBOSA MANRIQUEZ, ROSA MAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 274-0003
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosa Maria TIME COMPLETED:
12:20 PM
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On 12/01/2022 Licensing Program Analysts (LPA) Alemoh met with licensee Rosa Maria who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPA observed 0 children in care and 2 adults. (licensee and employee#1) Family members residing in the home include 1 adult (licensee). Facility hours of operation are Monday - Friday 6AM- 6 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the attached classroom. Per licensee the home is off-limits. The children use the bathroom located on the right side of the classroom. The off-limits areas are all bedrooms, two bathrooms, and kitchen. Laundry room and garage are also off limits and are kept locked during business hours. The classroom was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (which are kept in the home locked in a shelf) no medications are kept on the premises and hazardous items (sharp knives are kept in the off-limit home kitchen that is inaccessible to children).

Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the quiet area of the classroom.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BARBOSA MANRIQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413846
VISIT DATE: 12/01/2022
NARRATIVE
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Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 11/15/2022

Bathroom: LPA observed licensee properly stored cleaning compounds in a cabinet underneath the sink secured with a safety latch. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The classroom has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the off limit areas of the home which is locked during business hours. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently does have a food program. Naps are provided on mats the classroom.

Outdoor: The front yard and backyard is off limits. LPA noticed a playroom attached to the classroom where children can play. There is a gate separating the front yard and play yard. There is one dog in the premises. Per licensee, the dog does not come in contact when children are present. LPA observed age appropriate toys, well secured and safe for children. .

There are no bodies of water in the premises.

Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 08/24. Mandated Reporter expires on 12/17/23. LPA reminded licensee; mandated reporter training must be completed every 2 years.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
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: BARBOSA MANRIQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413846
VISIT DATE: 12/01/2022
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Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have child care insurance.

Licensee Maria 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.

LPA discussed the safe sleep regulations with licensee Rosa Maria and discussed the Child Care Licensing Safe Sleep web page 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.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC809 (FAS) - (06/04)
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