<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020268
Report Date: 06/30/2021
Date Signed: 06/30/2021 12:54:20 PM

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:
198020268
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Jocelyn Campos, LicenseeTIME COMPLETED:
01:00 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
Prior to entrance to the facility, LPA Mayra Rivera conducted a Covid 19 assessment and based on the licensee responses to the facility assessment questions, LPA Rivera determined safe to proceed. On Wednesday, June 30, 2021 at 10:22 AM, Licensing Program Analyst (LPA) Mayra Rivera conducted an annual inspection and met with Licensee Jocelyn Campos who guided LPA Rivera on a tour of the facility.

During the inspection, no daycare children were present. The licensee states that she currently has 4 children enrolled and no infants. LPA observed the current children’s roster posted on the bulletin board with 4 children listed. Family members residing in the home were present and are cleared. Operating hours are Monday to Friday, 6:00 AM to 6:00 PM and care for children ages 0 to 12 years.

This is a one story home which consists of 4 bedrooms, 2 bathrooms, kitchen, living room, dining room, family room (daycare room), front yard (fenced), and backyard (fenced). Per licensee and facility sketch areas off limits to children and parents include: 1 bathroom located by the living room , 4 bedrooms, living room, kitchen front yard, and shed located in the backyard.

At 10:25 LPA Rivera entered the daycare room area to inspect for safety, comfort, cleanliness, ventilation and working phone (land line). LPA observed a cubbie storage with children materials such as art supplies. LPA also observed a bookshelf with books, dramatic play area, and manipulative area. LPA observed the furniture and children materials to be in good condition and age appropriate. At 10:30 am, LPA Rivera entered the restroom and observed the toilet, running water, hand soap and paper towels. LPA observed the restroom to be in good condition and the water temperature set at 120 degrees. The children use the restroom located in the daycare room. At 10:38 AM LPA observed detergents, cleaning compounds, and hazardous items stored inside the side closet inaccessible to children. LPA observed a child proof lock round ball on the door knob to prevent children from opening the door making it inaccessible for children to open the door. Water is available at all times, LPA observed a water jug and paper cups. LPA did not observed a fire place.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198020268
VISIT DATE: 06/30/2021
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
26
27
28
29
30
31
32
 The licensee understands that any poisons or firearms must be locked with a key or combination lock. LPA observed family pet and licensee was not able to provide the immunization records due to the pet belongs to sibling

At 10:40 AM LPA Rivera observed the required 2A10BC fire extinguisher located in the daycare room and the valve on the green area indicating fully charged and serviced on 10/20/20. At 10:43 AM LPA asked licensee to press on the combo smoke/carbon alarm and LPA heard the sound of the alarm.

At 10:50 AM LPA inspected the outdoor area used by children in care for safety, comfort and cleanliness, LPA observed the backyard to be fenced and two side gates to be closed and locked with a self latch. The side gate with the metal gate is used for parents main entrance. The porch provides shade and LPA observed a shade sail over the playground equipment and artificial turf around the equipment. LPA observed the shed doors closed and with a padlock in place making it inaccessible to children. LPA observed play equipment to be in good condition and age appropriate.

LPA observed licensee pediatric First Aid/CPR certification (expires 05/22/2023). Licensee has proof of immunization against pertussis, measles and influenza declination The applicant completed the preventative health and safety training on 3/3/ 2019 and mandated reporter (AB 1207) training on 2/15/2018. Licensee has been informed that her AB 1207 has expired and needs to update her certification. The licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.



At 11:00 am LPA observed on the bulletin wall the parents rights, facility sketch, pediatric first aid certification, facility license, earthquake/fire drill log and emergency disaster plan.
The following was discussed: .

INFANT CARE: Licensee states currently has no infant in care. LPA Rivera reviewed and discussed Safe Sleeping Practices information with licensee and a plan for supervising sleeping infants. LPA advised the licensee to sleep infants in an area where infants can be directly supervised. Place infants on their backs to sleep, on a firm mattress with fitted sheet that fits snugly in crib or play yard. LPA also advised against sleeping infants in a separate room with no direct supervision and no pillows, crib bumpers, swaddling, head covered, and pacifiers must not have anything attached. Safe sleep brochure was provided.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198020268
VISIT DATE: 06/30/2021
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
26
27
28
29
30
31
32
LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee.. LPAs also explained to licensee that car seat, stroller are only and only for transportation, high chair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

Medication: Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

LPAs advised the licensee how to access forms, regulations and quarterly updates , and Providers Information Notices (PIN) on line at: www.ccld.ca.gov




LPAs issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s and staff files that were reviewed during this inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Licensee has been given an advisory notice to obtain pet immunization records and to update her AB 1207 mandated reporting certification. No citations being issued today.

Exit interview was conducted and plans of correction were reviewed and developed with Licensee, Jocelyn Campos. Appeal rights explained & provided. A copy of this report and appeal rights were discussed and left with licensee, Jocelyn Campos whose signature on this form confirm receipt of these documents.


.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3