426215873-11-19-2020-17-CC-MJIZ-BVJ2JR-20201119162647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215873
Report Date: 11/19/2020
Date Signed: 11/19/2020 04:27:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CAMARENA FAMILY CHILD CARE		FACILITY NUMBER:	426215873
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 9	DATE:	11/19/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Nora A Camarena		TIME COMPLETED:	04:45 PM

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 November 19, 2020 at 3:05 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced tele-inspection for the purpose of performing a Case Management, Change of Capacity inspection. Due to the COVID - 19 and California Department of Public Health guidelines of social distancing, a tele-inspection was conducted, via Zoom. LPA Jimenez met with Nora Camarena, Licensee and Licensee's Assistant. The purpose of the inspection was discussed with Licensee. There was one child in care at the time of the inspection. LPA Jimenez with the assistance of the Licensee conducted a virtual tour of the interior and exterior of the home. The home is a 4 bedroom, 3 bath, two story home with an attached garage. LPA observed the day care to be clean and orderly. The main day care area is the first floor which includes the kitchen, living room, dining room, day-care room, hallway bathroom and breakfast nook. LPA observed age appropriate books, toy, games, tables and chairs. The garage will be inaccessible to the children. There are safety gates at the base of the stairs, family room, dining room and kitchen, making the upstairs, family room, dining room and kitchen areas inaccessible to the children. The fireplace which is located in the family room has glass doors and will not be used. The bathroom used by children was observed to be clean and free of toxins. All hazardous items are stored inaccessible to children in care. The backyard is completely fenced. LPA observed a secured Jacuzzi inaccessible to children at the time of the visit. LPA observed that guns and ammunition are locked separately and are securely stored per regulation. The fire extinguisher was last serviced on 11/23/2020. Licensee is reminded to service or purchase the fire extinguisher yearly. There is a functioning carbon monoxide detector and smoke alarm in the home, which were tested at 3:45 PM, and meets statutory requirements. Licensee is current with immunization required per SB 792. CONTINUED ON 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2020

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAMARENA FAMILY CHILD CARE	FACILITY NUMBER: 426215873
	VISIT DATE: 11/19/2020

NARRATIVE

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Licensee CPR/First Aid certificate is current with an expiration date of 07/20/21. AB 1207 Mandated Reporter training certificate is valid until 1/17/21. Fire clearance was granted for 14 children by the Santa Maria Department on 11/13/20.

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

Licensee is reminded that they are responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed PIN 20-24, the handouts "Safe Sleep in Child Care, A Child Care Provider's Guide to Safe Sleep, and the Effects of Lead Exposure".

There were no deficiencies cited today. Exit interview was conducted with Nora Camarena, via tele-inspection. This report along with a copy of the Notice of Site Visit (LIC 9213) will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature.

The home meets Title 22 of Community Care Licensing requirements for a Large Family Child Care License effective today, November 19,, 2020.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2020

LIC809 (FAS) - (06/04)

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