013420689-7-12-2021-52-CC-MPRE-C4UTCZ-20210712143733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420689
Report Date: 07/12/2021
Date Signed: 07/12/2021 02:37:44 PM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	OCAMPO, LETICIA		FACILITY NUMBER:	013420689
ADMINISTRATOR:	OCAMPO, LETICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 355-4539
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	14	CENSUS: 0	DATE:	07/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Leticia Ocampo		TIME COMPLETED:	02:30 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 7/12/2021 at 12:40pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Leticia Ocampo for an unannounced annual inspection. Present during the inspection was the Licensee. There were no children during the inspection as the Licensee is closed for the week. Licensee lives in the home with her 15-year-old son. The Licensee’s home was toured for a health and safety inspection. The operating hours are 7:00am – 5:30pm Monday – Friday. ON LIMITS AREA: Living Room, Dining Room, Master Bedroom, Master Bathroom, 2^nd Bathroom, Multi-Use Area and Backyard OFF LIMITS AREA: Two (2) Bedrooms, Kitchen and Garage ISOLATION AREA: Living Room The facility is a single-story home rented by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there no firearms and no pets in the facility. The home has one (1) fully charged 3A40BC fire extinguisher in the hallway and one (1) fully charged 2A10BC fire extinguisher located in the dining room. There is one (1) working smoke detector in the hallway and the master bedroom, and one (1) working carbon monoxide detector in the hallway. The home is equipped with many windows for proper ventilation and central heat throughout the facility. Cont on 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: OCAMPO, LETICIA	FACILITY NUMBER: 013420689
	VISIT DATE: 07/12/2021

NARRATIVE

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At 1:30pm LPA obtained the facility roster, the two (2) Assistants files, and the children’s files. The files and the facility roster were complete. The Licensee’s Health and Safety training has been completed and CPR and First Aid training is complete with an expiration date of 1/2023. Licensee’s fire and disaster drill log is complete with the last drill logged 6/1/2021. All required forms are posted and visible for public view on the wall by the front door.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed as well. Licensee was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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.

Licensee is reminded that ALL Licensees, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.
Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Cont on 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: OCAMPO, LETICIA	FACILITY NUMBER: 013420689
	VISIT DATE: 07/12/2021

NARRATIVE

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Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Licensee for a signature. There are no deficiencies being cited today. This report shall remain on file for three (3) years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for thirty (30) days.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

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