198020268-11-16-2021-54-CC-MRIA-C8U2XW-20211116164750

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020268
Report Date: 11/16/2021
Date Signed: 11/16/2021 04:48:03 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 CARE		FACILITY NUMBER:	198020268
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	11/16/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Jocelyn Campos, Licensee		TIME COMPLETED:	04:55 PM

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On Tuesday, November 16, 2021 at 1:27 PM, Licensing Program Analyst (LPA) Mayra Rivera conducted a case management inspection for a capacity increase for a Large license and met with Licensee Jocelyn Campos who guided LPA Rivera on a tour of the facility. The Licensee is requesting a Large family childcare home license.

Family members residing in the home has been discussed with applicant and are cleared. Operating hours are Monday to Friday, 6:00 AM to 6:00 PM and care for children ages 0 to 12. LPA observed the current children’s roster posted on the bulletin board with 11 children registered. During the inspection, LPA observed four school age children and two infants.

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. LPA observed a safety gate in between the daycare room and hallway making it inaccessible to children enter off limit areas.

At approximately 1:49 pm LPA Rivera entered the daycare room area to inspect for safety, comfort, cleanliness, ventilation and working phone (land line). LPA observed a cubby 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. LPA did not observe a fireplace.

At approximately 1:55 pm, 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.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198020268
	VISIT DATE: 11/16/2021

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At approximately 2:00 pm 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 doorknob to prevent children from opening the door making it inaccessible for children to open the door. Knives and sharp objects are stored inside the kitchen drawer and a safety gate is in place making it inaccessible to children to enter the kitchen. Water is available at all times; LPA observed a water jug and paper cups.

LPA Rivera asked licensee if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated he has a pet (dog), no body of waters, firearms, weapons or poisons. LPA did not observe firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

At approximately 2:05 pm LPA Rivera observed the required 2A10BC fire extinguisher located in the hallway and the valve on the green area indicating fully charged and serviced tag dated 10/27/2021. LPA observed the carbon monoxide and smoke detector combo in the daycare room and LPA observed the red-light flashing which indicates the detector is functioning. LPA also observed the first aid kit in the daycare room and the fire/earthquake drill log with last drill conducted 10/4/21.

At approximately 2:10 pm 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 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 to open shed. LPA observed play equipment to be in good condition and age appropriate.

LPA observed licensee pediatric First Aid/CPR certification (expires 05/26/2023). Licensee has proof of immunization against pertussis, measles and influenza declination The licensee completed the preventative health and safety training on 3/3/2019 and mandated reporter (AB 1207) training on 6/30/21. The licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198020268
	VISIT DATE: 11/16/2021

NARRATIVE

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Safe Sleep: LPA discussed the safe sleep regulations with licensee Jocelyn Campos 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 Jocelyn Campos of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at also explained to licensee that car seat, stroller are only and only for https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. any

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA transportation, highchair 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 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

Criminal Record Statement: Licensee Jocelyn Campos was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA issued the Children's Record Review (LIC 857) to the licensee during the inspection. LPA explain to licensee the safe sleep plan form will need to be revised as the signatures are incorrect. Licensee has been given a technical violation for having a blanket in the playpen. LPA explained the requirements for safe sleep.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198020268
	VISIT DATE: 11/16/2021

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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.

Exit interview was conducted and plans of correction for technical violation were discussed with Licensee, Jocelyn Campos. A copy of this report and appeal rights were discussed and provided and left with licensee Licensee signature on this form confirms receipt of these documents

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

LIC809 (FAS) - (06/04)

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