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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617896
Report Date: 03/26/2025
Date Signed: 03/26/2025 03:06:12 PM

Document Has Been Signed on 03/26/2025 03:06 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/
DIRECTOR:		JUDITH CAMACHOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 607-5019
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/26/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Judith CamachoTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Loraine Perez and Andrea Cortez met with Licensee Judith Camacho, for the purpose of conducting an unannounced Case management inspection. There is a census of one infant and ten preschool children for a total of 11 children in care being supervised by the licensee and two assistants. The purpose of today's inspection was explained to the licensee.  Two of the three individuals subject to criminal background review have obtained a criminal record clearance. During today's inspection, LPAs conducted interviews, observed care, and obtained relevant documentation.

A health and safety inspection was conducted in the areas accessible to children. LPAs observed the home was safe, orderly, and free of hazards. LPAs reviewed staff files. Upon review of assistant records it was found that one adult assistant has not obtained criminal background clearance. Deficiency sited on LIC809D. A civil penalty was assessed at the time of inspection.  LPAs observed the downstairs bedroom door was closed where two children with blankets were laying in portable play yards.  Deficiency was sited and recorded on LIC809D.

Based on LPAs observations, and record review, the facility did not ensure all adults subject to criminal record review have obtained criminal record clearance.  The facility did not follow safe sleep regulations as evidenced by blankets in the portable play yards.  The facility did not maintain the door open while children were napping in portable play yards.
 
Amanda BlesiTELEPHONE: (916) 263-5721
Loraine PerezTELEPHONE: (916) 263-5744
DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAMACHO JUDITH
FACILITY NUMBER: 343617896
VISIT DATE: 03/26/2025
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The Licensee was informed that this report dated 03/26/2025 documents three Type A citations and must be posted for parental review for 30 consecutive days. The facility must also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in each child's file for verification.

Exit interview was conducted and a copy of this report was given to the Licensee Judith Camacho. Notice of site was given and must remain posted for parental review for 30 days. Appeal rights were provided.
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Loraine PerezTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2025 03:06 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: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/27/2025
Section Cited
CCR
102425(b)

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Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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Licensee stated she will remove the blanket from the cribs and talk with the parents about the importants to not have blankets in the cribs. LPA will return for a plan of correction inspection.
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Based on observation the licensee did not comply with the section cited above, there were blankets in the portable play yards with children napping posing an immediate risk to the health and safety of the children in care.
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Type A
03/27/2025
Section Cited
CCR102425(j)(5)

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The provider shall supervise infants... : If the infant is sleeping in a separate room from... the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
This requirement is not met as evidenced by:
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Licensee stated she will use a child size chair to maintain the door open while children sleep in the bedroom. Licensee did this at the time of inspection bring the facilty back into compliance for this citation.
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Based on observation the licensee did not comply with the section cited above, the bedroom door was not maintained open while an infant napped in portable play yard which poses an immediate risk to the health and safety of the children in care.
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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.
Amanda BlesiTELEPHONE: (916) 263-5721
Loraine PerezTELEPHONE: (916) 263-5744

DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2025 03:06 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: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/27/2025
Section Cited
HSC
1596.871(c)(1)(A)

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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:
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Licensee sent assistant during the inspection to have fingerprints taken. Licensee stated she will not have the assistant return until background clearance is complete. LPA will return for a plan of correction inspection.
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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.
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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.
Amanda BlesiTELEPHONE: (916) 263-5721
Loraine PerezTELEPHONE: (916) 263-5744

DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025

LIC809 (FAS) - (06/04)
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