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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414455
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:31:01 PM

Document Has Been Signed on 10/12/2023 03:31 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:RAMIREZ FAMILY CHILD CAREFACILITY NUMBER:
197414455
ADMINISTRATOR:KAREENA L. RAMIREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 891-5325
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marcella Ruiz and Amanda Rodriquez, StaffTIME COMPLETED:
03:45 PM
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On October 12, 2023, Licensing Program Analyst (LPA) Annelise Villa and Evelyn Garcia met with staff Amanda Rodriquez and Marcela Ruiz, who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival, LPA observed 4 children 2 infants and 2 preschool aged children in care. Adults living in the home are the licensee. Hours of operation are Monday-Friday, 7:00am-6:00pm. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: This 1 story, 3-bed, 2-bath with living area, kitchen and converted garage. Main care is provided in the living space. Children use the bathroom off the hallway on the right. Children have access to the living space, nursery and bathroom #2, and back yard. Off limit areas include the bedroom, bathrooms #1 in hallway (staff bathroom), front yard, and garage and both side of the home. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons. Cleaning supplies, medications and alcohol were inaccessible to children in care.

Safe and age-appropriate toys, play equipment and materials were observed. The smoke detectors were found to be non operable, and carbon monoxide detector batteries were observed by LPAs Garcia and Villa to be replaced by Staff#2. Fire Extinguisher (2A11BC) are all in operable condition and was serviced on 1/2/2023. Electrical outlets were inaccessible. No recalled and or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary. The facility sketch was not observed and per Staff #1 it is kept in the licensee’s room and they do not have a key for her room, there is working a telephone land line.

Bathroom: Children use the bathroom in the nursery room. LPA observed toilet handle to be broken, per Staff #2 it just broke and will be replaced. The tank lid is lifted and pump is pulled to flush toilet currently after each use and faucet are clean and operable. No hazardous materials or items were observed in bathroom #1. LPA reminded license the children's bathroom must be free of accessible shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: RAMIREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414455
VISIT DATE: 10/12/2023
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Kitchen: Sharp utensils are stored on the kitchen cabinet, however the kitchen is barricaded with a metal baby gate and inaccessible to the children. Medications are not kept in the home. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, Dinner and snacks are provided. Staff #1 stated they do not participant in a food program.

Outdoor: Children play in the back yard. LPA toured the back yard and observed it to be free of garden tools, poisonous plants, thorn trees, cactus, or lawn mower inaccessible to children. The play area is clear and clean of debris, play area is fenced and gated all around. LPA observed age appropriate play equipment for children. There is a plastic play structure on the right of the back yard and is placed over sand and 2 slides are on concrete. Per staff #2 they usually have rubber mats, however they were removed and will be replaced. LPA Garcia and Villa advised they should place rubber matting or some cushion to protect against falls. There is a converted garage that is barricaded with a metal gate approximately 3’ feet tall and has a latch opening which makes it inaccessible to the children. Both side of the backyard were observed to be gated off with high latches, making those areas inaccessible to children.

Pools/Spas/Bodies of Water: LPA observed no bodies of water on the premises.

Advisory/Other: First Aid kit was observed in the kitchen with supplies readily available. For staff #1 CPR/First Aid expires on 3/11/22, Staff #2 8/11/22 and licensee’s expired 3/15/21. Mandated Reporter Training Certificate for staff #1 was completed on 6/3/22, staff#2 6/13/22 and licensee on 6/15/22. LPA reminded licensee mandated reporter training and CPR must be completed every 2 years.

Licensee’s annual fees are current. LPAs did not observe required facility postings on premises. Staff #2 called licensee and was able to locate them. Staff #2 was informed that they are required to be posted and visible. Licensee had the following required posted documents: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203) and Emergency Disaster Plan (LIC 610A). However, LPA’s did not observe the following nor shown proof of Earthquake Preparedness Checklist (LIC 9148) and Fire/Disaster Log.

Documents Provided and or Discussed: Fire Drill Log, required postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have childcare insurance. LPAs Villa and Garcia discussed missing documents such as ID and Emergency Information in children’s files, Licensee’s CPR certification expired 3/15/21, earthquake preparedness, facility sketch, and infant safe sleep logs.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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: RAMIREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414455
VISIT DATE: 10/12/2023
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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 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: [email protected]. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep. More information on Infant Safe Sleep procedures can be found online on the CDSS 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

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: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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Document Has Been Signed on 10/12/2023 03:31 PM - It Cannot Be Edited


Created By: Annelise Villa On 10/12/2023 at 03:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: RAMIREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414455

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Licensee was not able to provide LPAs with valid CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/13/2023
Plan of Correction
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Licensee shall provide LPA with valid CPR certification. CPR/First Aid certifications must be completed through American Red Cross, National Heart Association, or any EMSA approved course.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 3 files reviewed. LPAs observed Child #3 did not have a separate file or a completed LIC 700 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2023
Plan of Correction
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Licensee shall have parent(s) of child #3 complete LIC 700. Licensee shall additionally create a separate file for Child #3.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Annelise Villa
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 10/12/2023 03:31 PM - It Cannot Be Edited


Created By: Annelise Villa On 10/12/2023 at 03:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: RAMIREZ FAMILY CHILD CARE
FACILITY NUMBER: 197414455

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above by stating "we thought it was from 0-12 months", whan asked if Safe Sleep documentation was being regularly completed for infants in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/12/2023
Plan of Correction
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Licensee and staff shall immediately being documenating infant safe sleep of all children in care aged 0-24 months.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Annelise Villa
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


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