192004328-7-28-2021-12-CC-AMAA-C5CQJ6-20210728121214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192004328
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:12:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

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: 0	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Elizabeth Camillo		TIME COMPLETED:	12:30 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	At about 10;25 AM Licensing Program Analyst (LPA) Mabika met with licensee, Elizabeth Camilo, who guided analyst on a tour of the facility for an Annual/Random inspection. This is a two story bedroom, bathroom home with kitchen, living room, dining room, laundry area, office, family room and garage. The garage is used for storage only and no childcare 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 and licensee's adult granddaughter). All were verified to be Live Scan cleared. No children were in care during the time of this inspection. 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 and LPA observed soap, paper towels, a touch free trash can and water temperature tested warm). 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) the garage and the garden section of the backyard that is fenced separately. 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. The house needed some cleaning and Licensee states that was the reason she was closed today for cleaning. Sharp knives in pantry cabinet, latch observed. Roster complete and maintained current with 10 children enrolled. Fire/earthquake drills are current and undertaken 07/23/2021 prior to which it was conducted monthly. LPA printed out and left a copy of the required Fire Drill Log Stairs are gated.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
	VISIT DATE: 07/28/2021

NARRATIVE

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Children play in the backyard. There is a concrete area for active play and there were age appropriate toys like biles, play houses, slide sets. Licensee has 3 small dogs (Licensee states they are vaccinated and she has certifications) and 1 bird in a cage. 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. Licensee states she will de-clutter the backyard.
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 (8 mats) on the premises. The required fire extinguisher (2A10BC) and another smaller one, 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 (Licensee was asked to send in the certification). Licensee failed to locate her CPR/First Aid certification as well her Mandated Reporter Training claiming her daughter was reorganizing her office. Licensee did states she has never been asked for the Mandated Reporter certificate. Licensee states she has not done any transportation for the last 2 years.
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: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
	VISIT DATE: 07/28/2021

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.

Licensee was cited a Type "B" deficiency for documentation were cited during this inspection.

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

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/28/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/24/2021 Section Cited	1 2 3 4 5 6 7	102416 Personnel Requirements In addition to any other required training... each family day care home licensee shall have... training ... pediatric first aid... This requirement was not met as evidenced by;
	8 9 10 11 12 13 14	Neither the licensee nor her assistant had current First Aid or Mandated Reporter Training This poses a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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