192004328-5-8-2019-12-CC-JNEL-BBYQRH-20190508122357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192004328
Report Date: 05/08/2019
Date Signed: 05/08/2019 12:24:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	CAMILO FAMILY CHILD CARE		FACILITY NUMBER:	192004328
ADMINISTRATOR:	CAMILO, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 236-2760
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY:	14	CENSUS: 1	DATE:	05/08/2019
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Elizabeth Camilo		TIME COMPLETED:	12:40 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	Licensing Program Analyst (LPA) Neal met with licensee, Elizabeth Camilo, who guided analyst on a tour of the facility for a case management continuation of an Annual/Random inspection. This is a two story 4 bedroom, 3 bathroom home with kitchen, living room, dining room, laundry area, office, family room and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 3 adults (licensee, licensee's son and licensee's girlfriend). All were verified to be Live Scan cleared. Incidental Medical Services (IMS) were discussed. Licensee currently has no children in care requiring IMS services. Main care is provided in the family and living/formal dining rooms. Children use the bathroom located down the hall to the right. Children have access to the backyard. Off limit areas include the home's entire gated upstairs, laundry area (gate observed), office (key lock), Bedroom #1 (downstairs, key lock) and the garage. 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. Medication are kept in the off limits upstairs bedroom. Sharp knives in pantry cabinet, latch observed. Roster complete and maintained current. Fire/earthquake drills are current. Stairs are gated.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
	VISIT DATE: 05/08/2019

NARRATIVE

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Children play in the backyard. There is a dirt and concrete area for active play. There are no swings or slides. There are small play structures. Licensee has 3 small dogs and 3 birds. There is a gate on the left side off limits to children and a dog run. There is a shed in the right rear corner (with key lock) that is off limits to children. There is another gated area beside the shed where lumber is stored.
Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There are age appropriate toys and napping equipment on the premises. The required fire extinguisher (2A10BC), carbon monoxide detector and smoke detectors are in operable condition. Fireplace is barricaded. Home has central AC and heat. LPA observed required documents posted. Licensee was reminded that Mandated Reporter training must be completed every 2 years for herself and any adult who assists in providing care.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in 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 tobacco in a private residence that is licensed as a family child care home and in those areas of the family child 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
	VISIT DATE: 05/08/2019

NARRATIVE

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To receive the quarterly updates on Community Care Licensing by email, please send your request to: Childcareadvocatesprogram@dss.ca.gov.

Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12 month period, PER PERSON.

The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. Notification of Parents' Rights poster (2015) was provided. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).
Hand out on Safe Sleep Concepts was given to the licensee.

No deficiencies were cited during this inspection.

An exit interview was conducted. A copy of this report was read and provided to the licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

LIC809 (FAS) - (06/04)

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