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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617896
Report Date: 10/23/2024
Date Signed: 10/23/2024 01:27:56 PM


Document Has Been Signed on 10/23/2024 01:27 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CAMACHO JUDITHFACILITY NUMBER:
343617896
ADMINISTRATOR:JUDITH CAMACHOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 607-5019
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:14CENSUS: 11DATE:
10/23/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Judith CamachoTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Loraine Perez met with, Licensee Judith Camacho (Licensee), for an unannounced inspection. Present are two staff, and Licensee. There is a census of four infants and seven preschool age children. Staff 1 is not associated to this licensed facility. Staff 1 will not return to the facility until their criminal background review is complete. A civil penalty of $100.00 was assessed at the time of inspection. All other individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 8:00 AM to 5:00 PM.

A health and safety inspection was conducted in the areas accessible to children. Off limit areas include the entire second floor, and garage. Licensee understands that children may never enter off-limits areas. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a 2A10BC fire extinguisher within the home. LPA observed the home was safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys. Licensee stated there are no firearms or bodies of water on the premises. Licensee stated there are no poisons on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPA observed all required postings, a fire drill log. LPA reviewed records of children’s files and staff files. Licensee will work with staff and families to complete missing records from files. Licensee has current EMSA-approved pediatric CPR/First Aid which expires 06/2026. Licensee understands both CPR and Mandated Reporter training must be completed every two years.

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.

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
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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Document Has Been Signed on 10/23/2024 01:27 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: CAMACHO JUDITH
FACILITY NUMBER: 343617896

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, Staff 1 is not associated to this licensed facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/24/2024
Plan of Correction
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Licensee stated Staff 1 will have fingerprints taken and associated to this facility before continuing to work with the children in care. LPA will conducted a return inspection to review records
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: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/23/2024 01:27 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: CAMACHO JUDITH
FACILITY NUMBER: 343617896

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not maintaining records for two staff of required immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee stated she will email staff immunization record of required immunizations Measles, Pertussis and Flu (for flu: or a letter to decline the flu vaccine). Records can be emailed to loraine.perez@dss.ca.gov. Licensee will send records by the plan of correction date November 25th, 2024
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, Licensee did not demonstrate documentation of childrens immunizations in the childrens files, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee stated she will collect childrens immunization records and update each child's file. LPA will return for a Plan of Correction inspection to review records.
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: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAMACHO JUDITH
FACILITY NUMBER: 343617896
VISIT DATE: 10/23/2024
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LPA reviewed with Licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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 Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource 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 at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, Licensee Judith Camacho confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files. A notice of site visit was given and must remain posted for 30 days. Licensee left for an appointment and report is reviewed with Staff 2. Exit interview conducted and report was reviewed with the licensee’s Staff 2 Beatriz Diaz Maya.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4