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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700833
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:24:11 PM

Document Has Been Signed on 06/06/2024 01:24 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:JONES-HENDERSON FAMILY CHILD CAREFACILITY NUMBER:
197700833
ADMINISTRATOR/
DIRECTOR:		MAPLE JONES-HENDERSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 233-5238
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
06/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Maple Jones-HendersonTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On June 6, 2024, at 8:36 AM Licensing Program Analyst (LPA) Joselito L. Del Mundo, conducted a Pre-Licensing inspection with applicant Maple Jones-Henderson to ensure the facility meets basic licensing requirements set forth by Title 22, (FCCH) with a capacity of fourteen children. The Fire Clearance was granted on May 24, 2024. Currently living in the home are three adults (applicant, applicant’s spouse, and adult son). Upon entering the facility, LPA was greeted by the applicant and applicant’s spouse. LPA observed one child during this visit and LPA asked if the child was the child of the applicant. Applicant stated that the child is not her son. Applicant thought that once she has a facility number, she can provide care. LPA explained to applicant that she cannot provide care and supervision until the inspection is completed and facility license was issued. Applicant told LPA that she will call the parent of the child and the child will be pick up at 2:00 P.M.

LPA toured the home indoor and out to ensure it meets FCCH requirements. The applicant is requesting to provide care for children ages six weeks to six years of age and is requesting the days and hours of operation will be Monday to Friday, from 6:00 A.M. to 6:30 P.M.

The home is described as follows:

This is a one-story home with four bedrooms, two bathrooms, kitchen, family room, living room, attached garage, and back yard. 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. There are zero bodies of water on the premises at the time of this inspection. Off-limits areas: bedroom 4, kitchen, and garage. The kitchen (Off-limits) has two child safety baby gates (retractable and metal) that separate it from the family room (On-limits). On limits: bedroom 1 (Master bedroom, Infant room), bedroom 2 (Toddlers room), bedroom 3 (Preschool room), bathrooms 1 and 2, living room, family room, and backyard (outdoor play area). The home has central heating and air-conditioning unit.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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 7
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: JONES-HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197700833
VISIT DATE: 06/06/2024
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Indoor:

The pulldown fire alarm is located next to the entrance door. LPA observed a single action doorknob. Per applicant, no one smokes in the home.

On limits:


Living room: (Located adjacent to the family room). LPA observed a television, small tables and chairs, cubbies, clothes rack, and other toys. The living room will serve as a common area for children.
Family room: (Located adjacent to the living room and kitchen). LPA observed a fireplace, two tables, chairs, and small four wheeled toys. The family room will be used as a dining area for children in care. The fireplace if covered with a plywood and is inaccessible to children.
Bedroom # 1 (Master bedroom, Infant room): Bedroom #1 was equipped with a closet, ceiling fan, and a bathroom. LPA observed a small refrigerator, bottle warmer, and gloves inside the closet. LPA also observed a small table, small chairs, two infant cribs, two highchairs, and a diaper changing table in bedroom 1. There is a child safety baby gate that between the room and the bathroom. LPA observed a small trash bin with lid. Per applicant, the trash bin will be used for storing soiled diapers. Toilet, faucet, and sink were clean and operable.
Bedroom # 2 (Toddlers room): Bedroom #2 was equipped with table, chairs, books, white board, light table, ceiling fan, and a closet. LPA observed day care supplies, small drawers, and gloves inside the closet.
Bedroom # 3 (Preschool room): Bedroom #3 was equipped with table, chairs, books, white board, arts and crafts, magnetic puzzles, art supplies, ceiling fan, and a closet. LPA observed six cots, baby dolls, and other toys inside the closet.
Bathroom #1: LPA observed toilet, faucet, sink, and a step stool. Toilet, faucet, and sink were clean and operable.
There is a child safety baby gate installed between the garage (Off limits) and the bathroom. 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.
Backyard (Outdoor play area): The play area is made up of concrete. LPA observed toy cars and other play equipment. There is a shade covering one of the play structures. LPA also observe a cushioning material on
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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: JONES-HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197700833
VISIT DATE: 06/06/2024
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the bottom of the slide. The air-conditioning fan unit does not have a cover and is accessible to children. The applicant was advised to put a cover for the fan.

Off-limit area
Bedroom # 4 (Applicant’s office room): (Located adjacent to the living room). Bedroom #4 was equipped with an office table, chairs, laptop, printer, ceiling fan, cabinets, and a closet. LPA observed children’s books and day care supplies inside the closet. The room will also be used as an isolation room.
Kitchen: (Located adjacent to the family room). Equipped with a refrigerator, stove, dishwasher, and a microwave. LPA observed the kitchen was clean and orderly. LPA observed the refrigerator, stove, dishwasher, and microwave were in good working conditions. The kitchen has two child safety baby gates (retractable and metal) that separate it from the family room (On-limits). Knives have caps and are stored inside the kitchen drawer and inaccessible to children.
Garage: Contained household materials for decorating, trash bin, and a bicycle. LPA also observed a parked SUV vehicle.
Napping equipment: LPA observe six cots inside the closet of bedroom #3.
Electrical outlets: Outlets in the on-limit areas have child safety plastic plugs.
Weapons or Firearms: Per the applicant there are zero firearms or weapons. LPA did not observe any weapons or firearms.
Poisons, Detergents and Cleaning compounds: Were observed under the kitchen sink (off limits).
A smoke detector and a carbon monoxide detector: Tested at 10:26 A.M. and are in operable conditions.
Fire extinguishers (2-A:10-B:C): The fire extinguisher is a 2-A:10-B:C classification and meets the State Fire Marshall standards.
First Aid Kit: First aid kit is stored inside the cabinet beside the kitchen. LPA observe a rigid tip digital thermometer.
Pets: Applicant does not have any pets.
Medications: LPA did not observe any medications.
Documentation:
Applicant completed the Prevented Health and Safety Training (8 hours) with the nutrition and lead components on 05/25/2024. Family Child Care Home Orientation was completed on 02/17/2024. Applicant
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: JONES-HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197700833
VISIT DATE: 06/06/2024
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has current CPR, First Aid Training completed on 01/29/2024 and mandated reporter training that was completed on 10/08/2022. Applicant and other adults living in the home have fingerprint clearance, required immunizations, and TB skin test on file. Applicant provided a copy of the first three pages of the Residential Lease Agreement.

Per Applicant, she will not be providing transportation to children in care. Meals and snacks will also be provided to children in care. Applicant stated that if the parents will bring food for their children, applicant will labeled the container with the child’s name and stored the food in the refrigerator.

The following was discussed with the applicant:

Mandatory licensing forms such as LIC 311D Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; The applicant was reminded that 100% supervision is required at all times to children in care; Applicant was made aware that it is 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; Regulation prohibits the smoking of any kind during the operation of the day care.

The applicant was made aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and to the Department on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. The applicant was informed to utilize the Unusual Incident Report/Injury Report form (LIC624B) when sending the report to the department. The report on unusual incident/injuries can also be mailed to [email protected]



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
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JONES-HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197700833
VISIT DATE: 06/06/2024
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and the ADA, available at: http://www.ada.gov/childqanda.htm.

Applicant was informed 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, 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 applicant and discussed the Child Care Licensing Safe Sleep webpage: atttps://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.



The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JONES-HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197700833
VISIT DATE: 06/06/2024
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Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy ofan inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.


Lead Flyer Requirement Health and Safety Code 1596.7996 mandated that effective January 1, 2019, CCC's and FCCH's are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement.

The applicant was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send them by email to: [email protected]. For additional information regarding the inspection and its tools and methods, please visit the CCLD website at: https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



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

LPA checked Megan’s Law website and confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JONES-HENDERSON FAMILY CHILD CARE
FACILITY NUMBER: 197700833
VISIT DATE: 06/06/2024
NARRATIVE
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As a result of this inspection, the home does not meet Title 22 Regulations. Final approval is pending the following:

1. Air conditioning unit fan cover and a metal fence shall be installed.


2. Applicant will purchase a non-contact infrared thermometer.

Applicant will submit pictures of the correction to LPA.

An exit interview was conducted, and a copy of this report and appeal rights were discussed with the Applicant, Maple Jones-Henderson.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
Page: 7 of 7