192004328-12-20-2023-12-CC-JTAO-CYPR3F-20231220113952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192004328
Report Date: 12/20/2023
Date Signed: 12/20/2023 11:40:41 AM

Document Has Been Signed on 12/20/2023 11:40 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	CAMILO FAMILY CHILD CARE		FACILITY NUMBER:	192004328
ADMINISTRATOR:	CAMILO, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 236-2760
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	12/20/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Elizabeth Camilo, Licensee		TIME COMPLETED:	12:00 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 12/20/2023 Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee Elizabeth Camilo. who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story, 4 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 1 foster child (over the age of 10), 1 preschool child, 1 school age child, and 1 infant. Family members residing in the home include 1 adult and 1 minor children. Facility operation are Monday-Sunday 23 hours a day. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the left Children have access to the living room and dining room only. Off limit areas include the entire upstairs (fully barricaded by safety gate), family room (barricaded by safety gate), all bedrooms, kitchen(barricaded by safety gate), laundry room, and garage. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (located in laundry room-off limits), medicines (master bedroom upstairs) and hazardous items (sharp knives in upper kitchen cabinet unreachable to children in care) that can pose a danger to children. LPA observed a fireplace in the the living room to be fully screened. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed. There is a designated area for ill children as necessary in family room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
	VISIT DATE: 12/20/2023

NARRATIVE

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Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster Drill was completed on 12/13/2023.

Roster complete and maintained current.

During file review, licensee did not have proof of immunization for children #1-3. Licensee will submit proof of vaccinations to LPA Tamayo no later than 01/03/2024. Facility has been cited a Type B Citation. Please see LIC809-D for additional information.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located in the laundry room and garage. Licensee cooks her own food for the day care children. Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in the living room.

Outdoor: At this time the backyard is currently off limits. Per licensee she is planning to clear
out the backyard for day care children. The backyard is completely fenced (with block cement). There is no body of water. LPA observed age appropriate toys. Per licensee, there is 3 dogs and 1 bird on the premises. Licensee will send a picture of the backyard cleared out to LPA Tamayo no later than 01/06/2023

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 01/11/2024. Mandated reporter expires 01/02/2025. There are no window cords accessible to children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
	VISIT DATE: 12/20/2023

NARRATIVE

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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Safe Sleep Log(Every 15 minute check). Licensee stated currently does not have child care insurance.

Licensee Camilo was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Camilo 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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Elizabeth Camilo, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/20/2023 11:40 AM - It Cannot Be Edited

Created By: Justeene Tamayo On 12/20/2023 at 11:19 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMILO FAMILY CHILD CARE	FACILITY NUMBER: 192004328
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. 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. Licensee did not have proof of vaccination records for children #1-3, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/03/2024
	Plan of Correction
1 2 3 4	Licensee will submit proof of vaccination records for children #1-3 no later than 01/03/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mariela Ramon

LICENSING EVALUATOR NAME:

Justeene Tamayo

LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

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