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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416405
Report Date: 09/05/2024
Date Signed: 09/05/2024 12:48:20 PM

Document Has Been Signed on 09/05/2024 12:48 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:KOWALCZYK FAMILY CHILD CAREFACILITY NUMBER:
197416405
ADMINISTRATOR/
DIRECTOR:		KOWALCZYK, CYNTHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 456-5166
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
09/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Licensee Cynthia Kowalczyk TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 09/05/2024 Licensing Program Analyst (LPA) Alemoh, met with Licensee Cynthia Kowalczyk and assistant #1 who guided analyst on a tour of the facility for the One Year Required inspection. This is one story home with 4 bedrooms, 2 bathrooms. Upon arrival LPA observed 2 children in care and the licensee and (assistant) caring for them. Family members residing in the home include 1 adult (licensee). Facility hours of operation are Monday - Sunday for 24 hours, per licensee overnight is provided upon parents request. Incidental Medical Services (IMS) policy was discussed.

There is no bodies of water on the premises.

Physical Plant: Main care is provided in the play room area in the backroom of the home, along with the nap room. LPA observed safe and age appropriate toys, play equipment and materials such as: books, blocks, costumes, and more. The nap room is utilized for children to do homework or to take naps. LPA observed the big kids room to be clean and orderly, along with bedding materials. The children use the bathroom located in the hallway to the left. The off-limits areas are all 1 bedroom, storage/guest room, and backyard #2. Laundry room and garage are also off limits and are kept locked during business hours.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KOWALCZYK FAMILY CHILD CARE
FACILITY NUMBER: 197416405
VISIT DATE: 09/05/2024
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 The home 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 underneath the kitchen sink w/ a safety latch along with medications stored in the upper kitchen cabinet with a safety latch, hazardous items (sharp knives are kept in the kitchen with a safety latch and are inaccessible to children).

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

Fire/Disaster drills are maintained current. Last fire disaster drill was completed on 02/12/2025. LPA did advise licensee to conduct a new fire drill.

Bathroom: LPA observed the toilet and faucet are clean and operable. The shower/tub area is free of prohibited items such shampoos, body wash and razors. LPA observed the cabinets to be locked with a safety latch containing body wash and shampoos.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are underneath the kitchen sink w/ a safety latch making it inaccessible to children. All kitchen cabinets are have safety latches. Breakfast, lunch, snacks and dinner are provided. Licensee stated she currently does not have a food program. Naps are provided on mats in the playroom.

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

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KOWALCZYK FAMILY CHILD CARE
FACILITY NUMBER: 197416405
VISIT DATE: 09/05/2024
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Outdoor: The front yard is off limits. There are two backyards. Backyard #1 is off-limits. The backyard is completely fenced in with a tall white fence. Backyard #2 is separated by a gate. There are one cat in the premises and they are de-clawed. Per licensee, cats do not come in contact when children are present. There are cameras around the property. LPA observed age appropriate toys, well secured and safe for children. Turf was observed around the play yard area. The turf field has rubber underneath making it safe for soft landings for the day care children. Play structures were observed to be safe and sturdy, there is a sand box that the play structures sit on. LPA observed the BBQ with a cover in backyard #1 to be off-limits and covered making it inaccessible to children.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 06/2026. Mandated Reporter expired on 04/28/24. LPA reminded licensee; mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have child care insurance.

Licensee Cynthia 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.

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

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KOWALCZYK FAMILY CHILD CARE
FACILITY NUMBER: 197416405
VISIT DATE: 09/05/2024
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LPA discussed the safe sleep regulations with licensee Cynthia 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. LPA observed safe sleep charts for infant in care.

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: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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