376627900-7-13-2020-20-CC-RGOU-BRGP3G-20200713105730

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627900
Report Date: 07/13/2020
Date Signed: 07/13/2020 10:58:02 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	CAMPOS, CLAUDIA FAMILY CHILD CARE		FACILITY NUMBER:	376627900
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	07/13/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Claudia Campos		TIME COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 07/13/20 at 10:00 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted a announced case management licensee initiated – capacity increase tele-visit. Upon visit, LPA met with licensee, Claudia Campos. There were no day care children in care at time of visit. Licensee's 16 year old son was present in the home at time of visit. This two story three bedroom and 2 1/2 half bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Facility operates Monday through Saturday from 6:00 a.m. to 12:00 a.m. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Required postings are posted inside the home near the front door, per observation. 2A:10BC fire extinguisher present in home and non-expired. Carbon monoxide and smoke detector observed and operational. Facility roster reviewed and complete. Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during inspection. Children will utilize the backyard for outdoor play. LPA informed licensee to ensure children are supervised during outdoor activities. There are no firearms or other weapons in the home, per licensee. Current pediatric CPR and first aid certificate on file. 8-hour Preventative Health Practices course on file. Primary telephone is a cell which is operational. A review of clearances on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee rents the facility and has provided proof of control of property by a rental agreement. Landlord consent on file. Licensee has met immunization requirements, per SB792 and has completed the AB1207 Mandated Reporter Training. Fire clearance was granted on 02/03/20. Family Childcare Self-Certification Checklist on file. See LIC809-Continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CAMPOS, CLAUDIA FAMILY CHILD CARE	FACILITY NUMBER: 376627900
	VISIT DATE: 07/13/2020

NARRATIVE

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Licensee will use the following areas for childcare: living room, dining room, bathroom located on first story of home and back yard. Off limit areas of the home include: kitchen, attached garage and second story of home including: three bedrooms and two bathrooms. Off limit areas of the home are made securely inaccessible, per observation. LPA discussed the following with licensee: children’s records/facility records/required postings-LIC911D, immunization requirements, unusual incident report-LIC624B, roster requirements-LIC9040, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), emergency drill log example, and the YMCA Resource Center.

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 provided 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.

LPA discussed California Megan's Law and provided Applicant with the following website: www.meganslaw.ca.gov. LPA informed applicant in order to access CCLD-Childcare regulations, licensing forms, pay annual fee to visit the following website: http://ccld.ca.gov. LPA discussed the following. LPA discussed the following with licensee: to sign up for Quarterly Updates and PINs for one or more programs through our website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. In addition, for questions contact Child Care Licensing duty line at 619-767-2248.

LPA discussed the following with Licensee: Max capacity when there is an assistant present: 12 children-no more than 4 infants (birth to 24 months). When caring for 14 children no more than 3 infants. 1 child in kindergarten and 1 child at least 6 years old. When there is no qualified assistant the capacity reverts to the requirements for a small childcare license. You must notify the parents of the children in care when caring for more than 12 children via LIC91520.

No deficiencies issued during today’s visit. An exit interview was conducted with licensee. The following was discussed and will be provided to licensee via email: LIC809, LIC809-C, LIC9213 – Notice of Site Visit and appeal rights. The facility is ready to be licensed after final file review. After final file review, License will be mailed to licensee. LPA informed Licensee upon receipt of the license, the license shall be posted in a prominent place in home. LPA informed licensee upon receipt of the LIC9213, LIC9213 shall be posted for 30 days from today’s date. COVID-19 State of emergency read receipt notification will be used in place of licensee’s signature

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020

LIC809 (FAS) - (06/04)

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