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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019329
Report Date: 08/30/2022
Date Signed: 08/30/2022 12:31:11 PM


Document Has Been Signed on 08/30/2022 12:31 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CAMPOS FAMILY CHILD CAREFACILITY NUMBER:
198019329
ADMINISTRATOR:CAMPOS, A. & CAMPOS, A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 480-3114
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:14CENSUS: DATE:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Alma CamposTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced Case Management Inspection on 08/30/2022 at 11:11am. LPA Navarro met with Licensee Alma Campos and Aroldo Campos who guided LPA on a tour of the facility. There was a total of two children present during the inspection. Hours of operation are Monday through Friday 5:00am to 8:00pm.

This is a one story home which consists of four bedrooms and two bathrooms. Areas used by the children include the living room, one restroom, backyard and patio. Per Licensee, areas off limits to children and parents include: four bedrooms, one restroom, kitchen, and dining room.

During today's inspection, LPA Navarro conducted interviews with the Licensee and children present. There were no deficiencies observed in regards to today's visit.

Exit interview was conducted with Licensee, Alma Campos. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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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