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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409074
Report Date: 10/20/2021
Date Signed: 10/20/2021 12:49:21 PM

Document Has Been Signed on 10/20/2021 12:49 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OCAMPO, ROBERTOFACILITY NUMBER:
073409074
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
10/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Roberto OcampoTIME COMPLETED:
01:02 PM
NARRATIVE
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On October 20, 2021, Licensing Program Analyst (LPA), Caroline Colson met with Roberto Ocampo and his assistant, Josefina I. Ramirez for an unannounced increase in capacity inspection at 10:13 AM. His teenage daughter arrived during the inspection. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 8:00 AM to 5:00 PM on Mondays - Fridays.

The home is a one story home. The home consist of three bedrooms, living room, kitchen, two bathrooms, fenced front yard, fenced back yard with barbecue area, a garage and a basement. The fenced back yard will be used for the outdoor play space. The master bedroom, master bathroom, barbecue area, a half of the fence front porch and garage are the inaccessible areas. There is 3A40BC fire extinguisher, a combination working smoke and carbon monoxide detector. He has central heating. Mr. Ocampo states that there are no firearms in the home. Mr. Ocampo provided a tax statement that he owns the property. There are toys available for the children. His CPR and First Aid certificates are current and expire on September 2022. The isolation area will be a converted bedroom which is the play room with sliding doors. There is one dog.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Please See LIC 809 C for additional information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: OCAMPO, ROBERTO
FACILITY NUMBER: 073409074
VISIT DATE: 10/20/2021
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· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov


· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

Incidental Medical Services (IMS) policy was discussed.

Licensee will remove gate from in between the living room and kitchen to barricade the two bedrooms and master bathroom. Licensee will purchase additional fitted sheets for the playpens.

The attached type A deficiencies are being cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

An exit interview was conducted. Appeal rights were discussed. This report must be available for public review for 3 years.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/20/2021 12:49 PM - It Cannot Be Edited


Created By: Caroline Colson On 10/20/2021 at 11:43 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OCAMPO, ROBERTO
FACILITY NUMBER: 073409074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/21/2021
Section Cited
CCR
102370(a)

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Criminal Record Clearance
Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption.
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By POC Due Date Licensee will ensure all adults working in the facility have a criminal record clearance.
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This requirement was not met as evidenced by document review and licensee interview. There is an adult woman working in the facility without a criminal record clearance. This poses an immediate health and safety risk to children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
Type A
10/21/2021
Section Cited
CCR102416.5(b)(3)

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Staffing Ratio and Capacity
More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.
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Licensee will reduce the number of infants to two (2) infants when having 8 children including two school age children.
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This requirement was not met as evidenced by document review and licensee interview. The are five (5) infants and three (3) preschool children present. This poses an immediate health and safety risk to children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2021


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