364818016-5-8-2024-12-CC-BIBE-D53Q27-20240508114639

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364818016
Report Date: 05/08/2024
Date Signed: 05/08/2024 11:46:49 AM

Document Has Been Signed on 05/08/2024 11:46 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	CAMPOS FAMILY CHILD CARE		FACILITY NUMBER:	364818016
ADMINISTRATOR:	CAMPOS, MARIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 707-5287
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	14	CENSUS: 6	DATE:	05/08/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Campos Mariana		TIME COMPLETED:	12:05 PM

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Licensing Program Analyst (LPA) Babatunde Ibitoye met with Licensee, Campos Mariana, who guided the analyst on a facility tour for a Annual/Random inspection. This is a single story 3-bedroom, 3-bathroom home with kitchen, dining, enclosed patio, laundry room, and garage. There is no pool/or body of water on the premises. Family members residing in the home include two adults (Licensee and licensee spouse). Days/hours of operation Monday through Friday from 6:am to 11:00pm. Incidental Medical Services (IMS) policy was discussed. Upon arrival, LPA observed six children in care along with Licensee, Spouse and one Assistant.

Physical Plant: The home is clean and orderly, the fireplace is screened, age-appropriate toys and play equipment, a working smoke detector and carbon monoxide detector, and a 2A10BC Fire Extinguisher, no one smokes in the home. There is a designated area for the ill child(ren) as necessary in the playroom at the entrance, no weapon/firearms, facility sketch complete and current, off-limit areas include all Bedrooms #1- #2, Bathroom #2, laundry room (safety knob) and detached garage. There is a working telephone (cell), poisons, and cleaning items inaccessible (in the laundry room, kitchen lower cabinets with a latch) to children. The home has central AC and heat.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room), medicines (off-limits bedroom), and hazardous items (sharp knives in kitchen cabinet with safety latch) that can pose a danger to children. Fire/earthquake drills were completed and maintained current (04/15/2024). Roster complete and maintained current.

Safe and age-appropriate toys, play equipment, and materials. Electrical outlets are inaccessible, and no baby bouncer’s saucer chairs or any recalled or prohibited toys or sleep/play equipment were observed on the premises. There are age-appropriate napping (cots, mat) equipment.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde Ibitoye	TELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 364818016
	VISIT DATE: 05/08/2024

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Bathroom: Shower/tub free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, and nail polish. The toilet and faucet are clean and operable.

Kitchen: Sharp items (knives in kitchen cabinet with safety latch) are inaccessible and the home has a clean fully stocked food refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Licensee serves Breakfast, lunch, dinner, and snacks.

Outdoor: The backyard was inspected; Fenced all around and gates were locked. AC unit is in the back yard on the left side of the home. LPA recommended the AC unit to have a cover. There was a locked storage shed that was checked. It had a living quarters and misc. items stored. There is a decorative water fountain in the backyard (no water) on the premises. There are two (2) dogs on the premises vaccination appointment scheduled for 05/15/2024, that are accessible to the children. LPA suggested to the licensee, that the two dog do not interact with the children during day care operating hours.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. The licensee has CPR/First Aid 02/2026 and the Mandated Reporter expires 01/18/26. Electrical outlets are inaccessible. There are no window cords accessible to children (string inaccessible).

Required Postings and Trainings Observed: Emergency Disaster Plan, Earthquake Preparedness Checklist, Notification of Parent’s Rights, Immunizations: MMR, Influenza, negative TB skin test for licensee and assistants all were current.

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 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde Ibitoye	TELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 364818016
	VISIT DATE: 05/08/2024

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The following was discussed with the Licensee: Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed, to be completed every two years; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is his/her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the daycare. Per the Licensee no one smokes in the home. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

The license advised of the requirement to report Unusual Incidents. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

The licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to part obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from the parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed change, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde Ibitoye	TELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 364818016
	VISIT DATE: 05/08/2024

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The licensee 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, before 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

LPA discussed the safe sleep regulations with the licensee and also instructed the Licensee to visit 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiency. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm. An exit interview was conducted, and the report was reviewed with the Licensee Campos Mariana

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde Ibitoye	TELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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