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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700281
Report Date: 05/17/2023
Date Signed: 05/17/2023 04:21:01 PM

Document Has Been Signed on 05/17/2023 04:21 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:SANDERS FAMILY CHILD CAREFACILITY NUMBER:
367700281
ADMINISTRATOR:DYESHA SANDERSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 669-8422
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ryan Collier, AssistantTIME COMPLETED:
04:30 PM
NARRATIVE
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On May 17, 2023, Licensing Program Analyst (LPA), Kuliema Calloway conducted an unannounced Case Management Inspection. LPA was met with licensee's assistant who granted access. LPA toured the home with the assistant. There were five day care children in care, and one child (2 yrs), not a day care child. One infant (1 yr), two toddlers (3 yrs and 4 yrs), and two school aged children (5 yrs and 8 yrs). There were three adults inside the home. Two assistants providing care and licensee's son. Licensee was not home during the inspection.

During the inspection, LPA observed cleaning supplies inside the children's bathroom, the stairs were not gated for the ages of children in care, there was one uncleared adult inside the home providing care, and a plugged in and running portable fan in the day care area (living room) while children were in care inside the living room. The two assistants were not providing 100 % supervision. LPA observed the assistants sitting in the family room on the couch near the kitchen on their cell phones while the minor children were in the child care area (living room).

There were two Type A deficiencies cited during the inspection: 102417(g)(4), and 102370 (a), and two Type B deficiencies: 102417(g)(3), and 102417 (b) cited during this inspection.
Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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: SANDERS FAMILY CHILD CARE
FACILITY NUMBER: 367700281
VISIT DATE: 05/17/2023
NARRATIVE
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LPA Calloway informed the site Assistant to provide a copy of this licensing report dated 5/17/2023 with the Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted and a copy of this report, Notice of Site Visit, and Appeals Rights were discussed and provided to the licensee. A Notice of Site visit was posted and must remain posted for 30 days. Removal of posting is subject to a $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/17/2023 04:21 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 05/17/2023 at 02:53 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: SANDERS FAMILY CHILD CARE
FACILITY NUMBER: 367700281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2023
Section Cited
CCR
102417(g)(4)

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102417(g) (4)The home shall be free from..conditions which might endanger a child. Safety precautions... include... cleaning compounds...which could pose a danger... stored where they are inaccessible to children. This requirement was not met as evidenced by:

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Licensee must provide proof that Assistant(s) were trained on how to properly store cleaning compounds when children are in care and provide proof to the Department by the POC date of 5/18/2023.
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Based on observation LPA toured the home and observed cleaning supplies inside the child's bathroom. Children in care were 1-8 yrs old which poses an immediate Health, Safety, or Personal Rights risk to the persons in care.
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Type A
05/18/2023
Section Cited
CCR102370(d)(1)

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102370(d)(1) All individuals subject to a criminal record review pursuant to HSC...1596.871 shall prior to working... residing...in a licensed facility: Obtain a clearance... record exemption...required by... Department. This requirement was not met as evidenced by:
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Licensee shall provide proof of cleared adult inside the home to the Department by POC date of 5/18/2023.
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Based on interviews, record reviews, LPA observed an uncleared adult assistant providing care and supervision to the children. LPA requested proof of clearance and assistant was unable to provide which poses an immediate Health, Safety, or Personal Rights risk to the children in care.
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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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2023 04:21 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 05/17/2023 at 03:18 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: SANDERS FAMILY CHILD CARE
FACILITY NUMBER: 367700281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2023
Section Cited
CCR
102417(g)(3)

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102417(g)(3)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include...: Where children less than five years old are in care, stairs shall be fenced or barricaded. This requirement was not met as evidenced by:
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Licensee will provide proof to the Department that the stairs are gated by the POC date of 5/24/2023.

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Based on obervation, LPA toured the home and found the stairs were not gated. There were infants and toddlers observed in the home, children ages 1- 8 yrs old. which poses a potential risk to the Health, Safety, or Personal Rights risk to the persons in care.
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Type B
05/24/2023
Section Cited
CCR102417(b)

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102417 (b)The home shall be with... ventilation for safety and comfort. This requirement was not met as evidenced by:
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Licensee shall maintain a comfortable temperature inside the home while children are in care and/or provide supervision to temporary ventilation. Licensee will provide proof that assistants were trained on providing supervision at all times to the Department by POC date of 5/24/23.
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Based on observation,LPA observed a portable fan running in the child care area not 100% supervised by the assistants providing care. LPA observed assistants... in other room while fan was running in area w/small kids which poses a potential Health, Safety, or Personal Rights risk for person in care.
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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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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