197492870-9-7-2023-12-CC-JDMO-CVFVZ9-20230907165222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197492870
Report Date: 09/07/2023
Date Signed: 09/07/2023 04:52:45 PM

Document Has Been Signed on 09/07/2023 04:52 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:	CARTER FAMILY CHILD CARE		FACILITY NUMBER:	197492870
ADMINISTRATOR:	CARTER, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 733-6984
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Nicole Timmons-Assistant		TIME COMPLETED:	04:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/07/2023, at 2:10 P.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Carter Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA Del Mundo met with Licensee’s assistant, Nicole Timmons and stated the reason for the inspection. The LPA provided copies of the LIC 126 Entrance Checklist Form, LIC 311D Forms/Records to Keep in the Family Child Care Home, and all records/forms that need to be maintain in the facility. Licensee guided the analyst on a tour of the day care areas. The day care take place in the following area of the home: living room, family room, den, bedroom #1, bathrooms #1 and #2, attached garage, and backyard (outdoor play area). Per assistant, the attached garage is under renovations. Licensee states the day care hours of operation is 23 hours, 7 days a week. Currently living in the home is just the licensee. Licensee is currently not providing transportation to children in care. During this visit, LPA observed zero children present in the facility. Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. LPA observed all cleaning products and detergents are stored in a cabinet under the kitchen sink and in the upper cabinet of the laundry room and secured with a safety lock. Knives and other sharp items, household medications are stored in the upper cabinet above the microwave oven of the kitchen. Per assistant, zero medications are currently being provided for the current children in care. Assistant stated that licensee is providing meals and snacks when she still has children enrolled in the day care. The facility is a two-story house, all upstairs rooms are off limits There is no fireplace in the facility. The home

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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: CARTER FAMILY CHILD CARE	FACILITY NUMBER: 197492870
	VISIT DATE: 09/07/2023

NARRATIVE

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has central heating and air conditioning units.

Based on records review, fire/earthquake drills were last conducted on May10, 2023, at 3:55 P.M. and is conducted once every two months. The facility has a fully charge fire extinguisher with a 2-A:10-B:C classification (reading in green, checked at 3:25 P.M.)

LPA observed safe and age-appropriate toys, table and chairs, cubbies, crib, toys, and books. Licensee provides sleeping cots for children to use and are stored in the family room of the facility.

Licensee has first aid kit box stored in the upper cabinet of the laundry room. The smoke detector and carbon monoxide detector are in operable condition (checked at 3:27 P.M.). LPA observed electrical outlets are covered with safety plastic plugs to prevent access by children in care. Assistant stated that licensee owns no firearms, and no one smoke in the facility.

Licensee is advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/ play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom #1 and #2: Toilet, sink and faucet were clean and in operable conditions. During the inspection, LPA did not observed razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care.

Currently, the licensee has zero children enrolled in the facility. Licensee stated that when a child shows signs of illness, he/she is separated from other children in bedroom #1 of the facility. Currently, bedroom #1 is under renovations,

Outdoor: The facility has a body of water on the premises. The outdoor play area has a covered porch and has age-appropriate toys and play equipment. LPA observed slides, bench for children, airplane, climber, and toy house. LPA Per assistant, she supervised children while playing outside.

At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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: CARTER FAMILY CHILD CARE	FACILITY NUMBER: 197492870
	VISIT DATE: 09/07/2023

NARRATIVE

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the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to [email protected]

Review of records to be maintained: LPA reviewed with licensee 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. LPA reviewed three children’s files, licensee, and assistant’s files. Based on records review, children’s files are complete; licensee and assistant have current mandated reporter trainings completed on 01/09/2023 and 01/05/2023 and CPR/First Aid trainings that were completed on 05/17/2022. Licensee has proof of immunization against measles, pertussis, and influenza. Licensee and assistant have TB skin test on file. Licensee’s assistant has proof of immunization against measles and influenza except for pertussis. Assistant is advised to provide a copy of her pertussis immunization records.

Licensee and other adults living in the home and working at the facility have received criminal record clearance.

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified.

The regulation prohibits the smoking of tobacco in a private residence 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, exersaucers, and any other items that fall into that category.

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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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: CARTER FAMILY CHILD CARE	FACILITY NUMBER: 197492870
	VISIT DATE: 09/07/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care 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 Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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

The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

The facility is not in compliance per Title 22 regulations. During today's inspection, LPA Del Mundo observed a deficiency that may hinder the health and safety of the children in care. Type B deficiency was cited during this inspection. An exit Interview and discussion of observations were conducted with the licensee.

Notice of Site Visit: A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
A copy of this Report was reviewed, and Appeal Rights were also provided to Licensee’s assistant, Nicole Timmons.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/07/2023 04:52 PM - It Cannot Be Edited

Created By: Joselito DelMundo On 09/07/2023 at 04:23 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: CARTER FAMILY CHILD CARE	FACILITY NUMBER: 197492870
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee’s assistant did not have an immunization record on pertussis which posed a potential Health, Safety or Personal Rights risk to persons in care.
	POC Due Date: 09/29/2023
	Plan of Correction
1 2 3 4	Licensee or licensee’s assistant will email a copy of immunization records on pertussis of assistant to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Lady King

LICENSING EVALUATOR NAME:

Joselito DelMundo

LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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