197413659-6-22-2021-12-CC-LKIG-C48V5Q-20210622160819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197413659
Report Date: 06/22/2021
Date Signed: 06/22/2021 04:08:27 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:	PENA & CAMPOS FAMILY CHILD CARE		FACILITY NUMBER:	197413659
ADMINISTRATOR:	PENA CAMPOS, SONIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 942-6971
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 2	DATE:	06/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Jorge and Sonia Campos		TIME COMPLETED:	04:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) King-Lewis conducted a required 1 year Inspection with licensees Jorge and Sonia Campos. At the time of the inspection LPA observed 2 day care children, licensees’ minor children (16 male) and four adults in the home (the licensees and licensees’ adult son and daughter). Licensee Sonia guided LPA on a tour of the license day-care area of the home. The day care take place in the following area of the home: Kitchen/Dining area, Family Room and Living Room, hallway Bathroom #1 the front side yard and rear yard for outdoor play. LPA did not observe any body of water on the premises. Family members residing in the home include the four adults (licensees and licensees’ three children).

Days/hours of operation Monday through Sunday less than 24 hours, as needed. Licensee is aware supervision is always required when children are in care. Licensee was informed that awake staff is required for overnight care.

Physical Plant: Licensee has camaras in the outdoor play area. Licensee states there are no firearms or other dangerous weapons. Storage areas for poisons are locked in outdoors storage area and garage. Licensee is aware Detergents, cleaning compounds, medications, and other items which could pose a danger to children shall be inaccessible to children. Fireplace is blocked with bookshelf and toys. Fire extinguishers, smoke detectors/carbon monoxide appear to be operable. LPA observed the home to be clean and orderly, central air and heating available. This is a single store home, no stairs inside home. LPA observed a land line telephone and cell phone. Licensee stated both phones are available and will be charge during day-care hours. Licensee states no infant care being offer at this time. LPA informed licensee infant play yard, or crib shall have a firm mattress and be empty when infant is present.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: PENA & CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197413659
	VISIT DATE: 06/22/2021

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Care and Supervision
Licensee is aware they must be present in the home and shall ensure that children in care are always supervised. Licensee stated she do not provide transportation. Licensee is aware no child shall be left in parked vehicles. LPA informed licensee to make sure she has the proper insurance to transport day care children daily if transportation is available in the future.

Licensee is aware the capacity stated on the facility license shall be the maximum number of children being cared for.

Licensee aware no infant shall be swaddled, and car seat shall not be used for sleeping. Licensee is aware to supervise infants, while they are sleeping by physically checking every 15 minutes and documenting the child status. Licensee should refer to regulation 102425(J) for documentation requirement. LPA reviewed requirement with licensee.

Facility Records Review
LPA observed facility Roster of Children showing 2 day care children that were present today. LPA observed current fire and disaster drill, current mandated reporter certificate, licensees’ immunization are current and licensees are aware that all employees or volunteer at the day-care shall be immunized against pertussis and measles and maybe immunized against influenza.

Facility Administration
Licensee aware she shall immediately remove any individual and prevent the individual for returning to the home or having contact with children in care upon notice from the department to remove an individual and all individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in the license home. Licensee is aware any authorized employee of the Department may enter and inspect any place providing

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: PENA & CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197413659
	VISIT DATE: 06/22/2021

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personal care and services at any time with or without advance notice. Licensee is aware other personnel shall complete training on preventive health practices including CPR and first aid per regulation 102416 (c).

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.

During this inspection the facility was observed to be in compliance with Title 22.

An exit interview was conducted, and a copy of this report and the notice of site visit, provided to licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC809 (FAS) - (06/04)

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