426215873-10-30-2024-17-CC-GGOZ-DAJRJ2-20241030130313

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215873
Report Date: 10/30/2024
Date Signed: 10/30/2024 01:03:30 PM

Document Has Been Signed on 10/30/2024 01:03 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CAMARENA FAMILY CHILD CARE		FACILITY NUMBER:	426215873
ADMINISTRATOR/ DIRECTOR:	NORA A CAMARENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 621-2428
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	10/30/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Nora Camarena		TIME VISIT/ INSPECTION COMPLETED:	01:15 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 October 30, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Required - 3 Year inspection at the above-mentioned Family Child Care Home (FCCH). LPA initially met with an assistant, however Licensee Nora Camarena arrived shortly after. At the time of the inspection there were 6 children present. LPA in the company of the Licensee toured the interior and exterior of the FCCH. LPA observed sufficient equipment for children in care. LPA observed the children's area is enclosed by a child gate and the kitchen is inaccessible to children. LPA notes medication and sharps are stored in the kitchen. LPA observed baby walkers inside the children's area however, they are not in use as the only infant in the home can already walk. LPA informed Licensee these items are not permitted in a FCCH and informed Licensee they must be removed. LPA observed the bathroom to be clean and orderly. LPA observed cleaning compounds under the sink were not secured. Further LPA observed a different cleaning product on a counter that was accessible to children in care. 1 Type B deficiency is being issued on the attached LIC 809D. LPA observed the stairs are secured with a child proof gate. LPA observed the backyard to be completely enclosed. LPA observed a play structure that is in good condition. LPA observed the backyard to have sufficient space for children's activities. LPA observed the exit ways of the home to be secured. LPA observed a storage shed that contains children's materials and has the ability to be locked. The FCCH has a smoke and carbon monoxide detector which was tested at 10:15AM and found in working order. LPA observed the FCCH to have a regulation fire extinguisher which was serviced on 10/7/2024. LPA reminded Licensee to either service or purchase a regulation fire extinguisher annually. CONTINUED PAGE 2

Ana Tolentino	TELEPHONE: (805) 562-0347
Giovani Gonzalez	TELEPHONE: (805) 722-5132
	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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 10/30/2024 01:03 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAMARENA FAMILY CHILD CARE	FACILITY NUMBER: 426215873
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in having cleaning products stored in unlocked cabinets and placed on an accessible counter which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	During the inspection objects were removed from accessible areas. Licensee will provide a written statement to LPA on how they will ensure cleaning products are not accessible to children in care no later than 11/06/2024 via email at giovani.gonzalez@dss.ca.gov

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record review and interview, the licensee did not comply with the section cited above in not documenting safe sleep checks for the infant they care for, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/13/2024
	Plan of Correction
1 2 3 4	Licensee will provide documentation of safe sleep checks for the next 2 weeks. Licensee will provide the documentation to LPA via email at giovani.gonzalez@dss.ca.gov

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: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/30/2024 01:03 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAMARENA FAMILY CHILD CARE	FACILITY NUMBER: 426215873
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in neither themselves or assistant having a current Mandated Reporter Training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	Licensee and assistant will provide an updated Mandated Reporter Training(AB 1207) to LPA via email at giovani.gonzalez@dss.ca.gov no later than 11/06/2024.

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 6 children's file not being available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	Licensee will provide file for the children that were present during the inspection. Licensee shall provide files to LPA via email at giovani.gonzalez@dss.ca.gov.

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: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAMARENA FAMILY CHILD CARE	FACILITY NUMBER: 426215873
	VISIT DATE: 10/30/2024

NARRATIVE

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LPA reviewed 3 of 6 children's records which were found to be complete. LPA notes Licensee was unable to provide files for 3 other children present. 1 Type B deficiency is being issued on the attached LIC 809D. Licensee informed LPA they do check infant safe sleep however they are not documenting the checks. 1 Type B deficiency is being issued on the attached LIC 809D. LPA reminded Licensee that it is their responsibility to ensure that children's records are complete. LPA reviewed assistant's file which was found to be complete. LPA observed Licensee's and assistant's Mandated Reporter Training to be expired. 1 Type B deficiency is being issued on the attached LIC 809D. LPA notes Licensee's Pediatric First Aid and CPR was completed on 11/5/2023 (expires 11/2025). LPA notes the FCCH has fire arms that are stored in accordance to regulation. LPA reminded Licensee that it is their responsibility to ensure all training and certifications are current.

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.

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.

LPA discussed the safe sleep regulations with licensee and discussed 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.

CONTINUED PAGE 3

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAMARENA FAMILY CHILD CARE	FACILITY NUMBER: 426215873
	VISIT DATE: 10/30/2024

NARRATIVE

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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.

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

4 Type B deficiencies were issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Nora Camarena. Appeal Rights were given.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani Gonzalez	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC809 (FAS) - (06/04)

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