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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020268
Report Date: 08/02/2024
Date Signed: 08/02/2024 12:17:09 PM

Document Has Been Signed on 08/02/2024 12:17 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:
198020268
ADMINISTRATOR/
DIRECTOR:		JOCELYN CAMPOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 234-7592
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
08/02/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Jocelyn Campos, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:36 PM
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Licensing Program Analysts (LPAs) Susann Sanchez and Joshua Ortega conducted an announced inspection at the facility noted above and met with Licensee, Jocelyn Campos to conduct an annual inspection. Licensee guided LPAs on a tour of the facility. Operating hours would be Monday through Friday from 06:00 AM to 06:00 PM. The Licensee is cares for children birth to 12 yrs old. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. During todays inspection there was one infant, one child two adults (fingerprint cleared) with the licensee.

Tour began at 10:00am. 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, kitchen, laundry room, 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.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 07/01/24. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced in 03/22/2024. The Licensee maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are inaccessible to children. Licensee understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020268
VISIT DATE: 08/02/2024
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Currently licensee cares for three infants. Licensee was reminde of the following: d Napping equipment does not block entrances or exits. 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.

At 10:10am, LPAs toured the backyard. Per Licensee, children use the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for the children to play with. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water. Licensee stated that children go on field trips from time to time with parents permission.

At 10:40am,LPAs reviewed records. Children’s records were reviewed for Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights. Licensee's records were reviewed for approved Pediatric First Aid and CPR certification (expires 05/13/2025), proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. At 10:47am, during Licensee file review, Licensee's mandated reporter expired on 05/2024. Per licensee was waiting on Union to offer class. LPA's explained she can take class online. Licensee started class during inspection. A technical violation was given.

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.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020268
VISIT DATE: 08/02/2024
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Licensee was informed of the MyChildCare.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resources and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
During the exit interview Licensee Campos, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Campos.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC809 (FAS) - (06/04)
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