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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020501
Report Date: 03/02/2023
Date Signed: 03/02/2023 06:39:55 PM


Document Has Been Signed on 03/02/2023 06:39 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:CAMPOS FAMILY CHILD CAREFACILITY NUMBER:
198020501
ADMINISTRATOR:ROCIO CAMPOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 477-3742
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 10DATE:
03/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Rocio Campos, LicenseeTIME COMPLETED:
06:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced annual required inspection. LPA met with licensee, Rocio Campos who guided analyst on a tour of the facility. The licensee's assistant Sandy Fuentes was also present during this inspection. There were ten(10) children present during LPA’s arrival with six (6) being infants. Licensee states that there are currently 14 children enrolled.

Family members residing in the home are 2 adults (criminal record clearances on file) and no children residing.

This is a two-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, family room (main day care room), garage, front yard (unfenced), side and back yard (fenced). The children use the restroom near the bedroom #1 (located downstairs), living room, bedroom #1 (play room), kitchen, family room (main day care room), and back yard. Per licensee, areas off limits to children and parents include: 2 bedrooms and 1 bathroom (located in the second floor), garage, front and side yards. The LPA toured all areas used by children during this visit.

During this tour, the following was noted: At 1:50 p.m., LPA was toured through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. At 1:50 pm, LPA observed one (1) infant napping on a swing and one (1) infant napping on the play yard located in the living room, upon inspection of the kitchen at 1:51 pm., one (1) infant on a Exersaucer, one (1) infant sleeping on a baby bouncer and another infant was observed awake on a floor seat. Upon inspection of the family room (main day care room; One infant (1) was observed napping on a baby bouncer, one (1) preschool age child napping on a baby bouncer and three (3) preschool age children were napping on floor mats. At 1:52 p.m., LPA observed one (1) infant on a baby bouncer awake in the bedroom-Play room (pictures were taken). At 2:06 p.m., LPA observed cleaning compounds accessible in the kitchen stored in the children’s cubbie bottom shelf. At 2:07 pm, LPA observe poisons (Roach & Ant Killer), cleaning compounds, accessible in the kitchen sink cabinet which was unlatched (Pictures were taken). At 2:08 p.m., LPA observed medications, vitamins accessible in the kitchen cabinet with no latch (Pictures were taken). LPA discuss with licensee that poisons must be locked with a key or combination lock, Licensee immediately removed poison and placed in locked garage. There is a working telephone service maintained in the home.
REPORT CONTINUES ON NEXT PAGE 1 OF 3.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
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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Document Has Been Signed on 03/02/2023 06:39 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation of poison (Ant & Roach killer), medications, cleaning compounds were accessible in the kitchen, this poses an immediate risk to the health and safety of children in care.
POC Due Date: 03/02/2023
Plan of Correction
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During LPA's inspection Licensee removed poison from kitchen cabinet and placed in locked garage, medications and cleaning compounds were placed in a kitchen cabinets that are inaccessible to children in care.
Type A
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation of one infant placed in a Excersaucer and other children in care napping on baby bouncers, this poses an immediate risk to the health and safety of children in care.
POC Due Date: 03/02/2023
Plan of Correction
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Per Licensee, she will return Excersaucer to child's parent and will no longer use for the day care including baby bouncers. A written declaration was obtained by Licensee with compliance plan.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2023 06:39 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation of six (6) infant children in care during today's inspcetion, this poses an immediate risk to the health and safety of children in care.
POC Due Date: 03/02/2023
Plan of Correction
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Per Licensee, she will disenroll two (2) infants from her day care program to comply with the conditions of licensure; Max capacity when there is an assistant present: 12- No more than 4 Infants. Cap 14- No more than 3 infants; 1 child in Kindergarten or Elementary School and 1 Child at least age 6. LPA obtained written complaince statement from Licensee on a LIC 855.
Type A
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of children in care napping on swings, baby bouncers and placing awake infants on floor chairs/baby bouncers with no activity nor feeding this poses an immediate risk to the health and safety of children in care.
POC Due Date: 03/02/2023
Plan of Correction
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In addition, Licensee will attend Family Child Care Home Orientation for a refresher on regulations and operation requirements on 03/14/23 at 8:30 am., at the Monterey Park Regional Office 1000 Corporate Center Dr, Suite 200B Monterey Park, CA 91754 and will submit to LPA Garcia a copy of certificate of completion.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2023 06:39 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation of provider not having one crib/play yard for each infant in care. This poses a potential health and safety risk to children in care.
POC Due Date: 03/03/2023
Plan of Correction
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Per Licensee, she has play pens available in storage and will make them available and will take pictures and will sent to LPA Garcia via email by POC due date 3/3/23 to clear this citation.
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation of infant children in care napping on swings and baby bouncers during this inspection. This poses a potential health and safety risk to children in care.
POC Due Date: 03/02/2023
Plan of Correction
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Per Licensee, the napping equipment will be readily accessible to be used when children are napping and has reviewed PIN 20-24-CCP and a written compliance plan has been obtained on LIC 855 from Licensee.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2023 06:39 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review of Child #1 was missing documentation. This poses a potential health and safety risk to children in care.
POC Due Date: 03/17/2023
Plan of Correction
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Per Licensee, she will obtain required enrollment documents for Child #1 prior to child #1's return to day care. Licensee will send LPA Garcia via email a scan copy of the child's file by POC due date 03/17/23
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020501
VISIT DATE: 03/02/2023
NARRATIVE
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LPA observed and inspected sleeping equipment for infants. LPA observed only three (3) play yards available, however, only one (1) play yard was being used by one (1) infant in care. LPA inspected play yard equipment which meet the US Consumer Product Safety Commission safety standards. LPA observed that play yards are free from loose articles and objects. There are no objects hanging above or attached to the side of the play yards. LPA observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Mats were observed to be firm and covered with a fitted sheet that is appropriate to the mat size. Per Licensee, each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were observed. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. In addition, Licensee was advised that the provider must have one crib or play yard for each infant in care.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was review. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy in English was provided to the Licensee during this inspection.

Per licensee, there are no pets, weapons, firearms or bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged with a service tag dated 03/25/2022. Smoke detector and carbon monoxide detector in the kitchen which were tested at 2:21 p.m., and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 10/2024.

Incidental Medical Services (IMS) policy was discussed. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers
REPORT CONTINUES NEXT PAGE 2 OF 3.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198020501
VISIT DATE: 03/02/2023
NARRATIVE
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The following was discussed:
  • Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
  • The Licensee shall be present in the home and shall ensure that children are supervised at all times.
  • Children shall not be left in park vehicles.
  • The capacity specified on the license shall be the maximum number of children for whom care can be provided.
  • Car seats shall only be used for transportation purposes and shall not be used for sleeping.
  • All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
  • When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined. PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records a copy of the LIC 9224 was provided. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: www.ccld.ca.gov

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with facility representative, Rocio Campos.
REPORT ENDS HERE PAGE 3 OF 3.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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