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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419186
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:02:10 PM


Document Has Been Signed on 02/15/2024 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CAMPOS FAMILY CHILD CAREFACILITY NUMBER:
197419186
ADMINISTRATOR:CAMPOS, EPELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 772-6186
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:14CENSUS: 9DATE:
02/15/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Licensee, Epelina Campos TIME COMPLETED:
01:10 PM
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On 02/15/2024 at 10:05am, Licensing Program Analyst (LPA), Sarah Garcia conducted an unannounced Required Inspection at the above-mentioned facility. LPA was greeted by licensee, Epelina Campos. During the initial inspection, LPA observed 9 children in care. Present during today's inspection was licensee's husband who assists with the daycare. All adults are fingerprint cleared. Facility operates Monday through Friday from 7:30 a.m. to 5:00 p.m. Currently licensee is available to care for children 0 to 12 years old. Facility is Large Family Child Care Home with a max capacity of 14. Licensee does not provide transportation to children.

LPA toured the home inside and outside. The home is a single-family home with 1 and a half bedrooms and 1 bathroom, living room, dining room, kitchen area, outdoor area, and detached unit located in the back of the home. Licensee confirmed the following areas are designated for day care only: Living room, bathroom, and outdoor area. LPA inspected the living room and observed the space to be clean and orderly. LPA observed a barricaded wall heater. LPA observed one play yard and mats to utilize for sleeping children. LPA observed age-appropriate toys, materials, children's tables and books. The bathroom that children use is located near the kitchen area and dining room. LPA inspected the bathroom and did not observe any medications, toxins or cleaning compounds accessible to the children in care. LPA observed a two safety gates at the entrance of the kitchen and dining room area. LPA inspected the kitchen and observed the knives and sharp objects to be out of reach to the children. LPA observed a safety latch under the kitchen sink cabinet to ensure all poisons, detergents, cleaning compounds, medications and other items which can pose a risk to children in care made inaccessible. LPA observed safety covers on the stove knobs. LPA observed a safety gate at the entrance of the bedroom. LPA inspected the 1 and a half bedroom and observed the space to be clean and orderly.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 197419186
VISIT DATE: 02/15/2024
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The following areas are OFF LIMITS to the children in care: 1 Bedroom, kitchen area, dining room, and detached unit in the back of the home.

LPA inspected the outdoor area and observed safe toys and play equipment. The outdoor area is properly fenced and supervised at all times. LPA observed a washer and dryer. LPA observed a broken window on the side of the home. Per licensee, the window was recently broken and will be fixed by 5pm today. The detached back unit remains locked at all times.

Per licensee, there are (2) dogs in the home. LPA discussed the importance of making sure that parents know program has pets in the home. Dogs remain locked in off limits bedroom in the home.



All electrical outlets were observed to be covered. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed, locked, and made inaccessible when children are present.

LPA observed licensee's husband test the carbon monoxide detector in the home. LPA observed licensee's husband test the smoke detector in the home. One working fire extinguisher 2A10BC was observed. LPA observed first aid kit with gauze and Band-Aids. LPA instructed licensee to purchase a touch less thermometer. Licensee provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted. When a child is ill licensee will isolate them in the bedroom.

No swimming pools or bodies of water were observed in the space. There are no firearms or ammunition on the premises.

Licensee currently does not administer medication. Adequate ventilation for safety and comfort were observed in the space. The home has working telephone service and LPA confirmed the phone number (424) 772-6186.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 197419186
VISIT DATE: 02/15/2024
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LPA reviewed 9 children’s files and observed files to be incomplete. LPA discussed missing documents and developed plan of correction. LPA observed the earthquake and fire drill log. LPA discussed all necessary forms needed in each children’s file and provided licensee with the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy to use as a reference when auditing files.

LPA reviewed licensee's Pediatric CPR and first aid certification and observed certification was an expiration date of 11/2025. LPA reviewed licensee's Mandated Reporter certification and observed certification with an expiration date of 11/2025.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA 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: https://www.ada.gov/resources/child-care-centers/.



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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 197419186
VISIT DATE: 02/15/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Epelina Campos, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies will be cited today.

Exit interview conducted and report along with appeal rights was reviewed with the licensee, Epelina Campos.

A notice of site visit was given and must remain posted for 30 days.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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