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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420689
Report Date: 10/06/2021
Date Signed: 10/06/2021 12:43:46 PM

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, LETICIAFACILITY NUMBER:
013420689
ADMINISTRATOR:OCAMPO, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 355-4539
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:14CENSUS: 14DATE:
10/06/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Leticia Ocampo- LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
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On 10/6/21 at 12:05pm, Licensing Program Analyst (LPA) Briana Plumboy met with Licensee Leticia Ocampo to conducted an unannounced Case Management inspection. LPA Plumboy was at the facility for another purpose, which resulted in a case management inspection. Present for the inspection was 4 infants, 10 preschool age children, and 2 fingerprint clear and associated staff.

The licensee is operating out of ratio during today's inspection.

The attached Type A deficiency is cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file.

This entire report has been read to by LPA Plumboy. The staff is aware the signature on this report confirm receipt of these documents. LPA asked Ms. Leticia Ocampo if she had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given. At this time it was stated there are no further questions at this time. At anytime she can reach out to LPA Plumboy or CCLD.



See 809-D for deficiency cited today. Appeal rights discussed and provided. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days along with a copy of this entire report. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2021
Section Cited

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More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
THE FACILITY IS OUT OF RATIO TODAY. WHEN LPA ARRIVED AT THE FACILITY, PRESENT WAS
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2 ASSISTANTS AND 14 CHILDREN PRESENT WHO ARE NOT SCHOOL AGE CHILDREN. LPA PLUMBOY DISCUSSED THE AGE REQUIREMENTS TO STAY IN COMPLIANCE WITH RATIO. WHEN A FACILTY IS OUT OF RATIO, THIS POSES AN IMMEDIATE RISK TO CHILDREN IN CARE.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2021
LIC809 (FAS) - (06/04)
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