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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610566
Report Date: 12/22/2021
Date Signed: 12/22/2021 06:03:05 PM

Document Has Been Signed on 12/22/2021 06:03 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CAMPISTA, JOSEFA FAMILY CHILD CAREFACILITY NUMBER:
136610566
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Josefa and Jose CampistaTIME COMPLETED:
06:00 PM
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On 12/22/21 at 1:00PM, LPAs, Luigi Gargaro and Claudia Amador, conducted an announced prelicensing inspection with the applicant and her spouse, Jose Campista. The applicants is primarily Spanish speaking but analyst Amador assisted in providing translation during today's visit. The purpose of the visit is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Analyst inquired if there are any bodies of water or weapons in the home and the applicant replied no. A review of records on this date indicates that all adults or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant owns the home and provided proof of control of property in the form of a mortgage statement for the home with her original application. First Aid and CPR certifications expire on August of 2023 for the applicant.

Applicant will be using the following rooms for childcare: the family/main day care room, the second dedicated day care area, bedroom #2 and the day care bathroom. The following areas will be off limits: the kitchen, bedrooms #1 and #3 and the inclusive master bath. The kitchen is made off limits with a child safety gate that is securely installed at the entrance way between the kitchen and the primary day care room while both bedrooms are made off limits with door knob covers that are installed on their respective door handles. The applicant has sufficient toys and equipment available. The home has a fenced front yard available for outdoor activities. The home also has a fenced backyard that is off limits as it stores the licensee's personal items. The back yard is made off limits with two latching side gates that make it inaccessible to children in care.

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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CAMPISTA, JOSEFA FAMILY CHILD CARE
FACILITY NUMBER: 136610566
VISIT DATE: 12/22/2021
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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 and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis.

The new provider packet was reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, shaken baby syndrome and SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care.

A license for 8 will be issued after the following corrections: applicant has a play structure that is not appropriate for all age children and prefers to remove it rather than make any modifications to it; applicant also has a play house that has a window frame that needs to be secured and sanded down. Applicant will send a photo demonstrating the removal of the play structure and repair of the playhouse window frame to analyst by 12/29/21 and will be issued a license upon receipt of the proof of corrections. Community Care Licensing web site: http://ccld.ca.gov
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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