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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192004328
Report Date: 10/15/2024
Date Signed: 10/15/2024 12:43:29 PM

Document Has Been Signed on 10/15/2024 12:43 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CAMILO FAMILY CHILD CAREFACILITY NUMBER:
192004328
ADMINISTRATOR/
DIRECTOR:		CAMILO, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 236-2760
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Elizabeth Camilo, Licensee TIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 10/15/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with adult #1. Licensee Elizabeth Camilo came shortly after from a medical appointment. Licensee 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 2 preschool children and 1 infant in care. 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.

During file review, adult #1 did not have proof of fingerprint clearance. Licensee will have adult #1 fingerprint cleared and associated before adult #1 is able to work in the facility. Facility has been cited a Type A Citation. Please see LIC809-D for deficiency page. An immediate $100 civil penalty has been assessed. This report cites a Type A violation and shall be provided to the parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 and must be kept in each child's file.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the left hand side. Children have access to the living 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(barricaded by safety gate), 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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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: 10/15/2024
NARRATIVE
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LPA observed a fireplace in the the family 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).

Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster Drill was completed on 10/15/2024.

Roster complete and maintained current.

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 submit picture to LPA before day care children are allowed in the backyard.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMILO FAMILY CHILD CARE
FACILITY NUMBER: 192004328
VISIT DATE: 10/15/2024
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Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 07/08/2026, however the CPR was completed online. Licensee will retake her CPR/First Aid and send proof of completion to LPA Tamayo no later than 12/15/24. Mandated reporter expires 01/02/2025. There are no window cords accessible to children.

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: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/15/2024 12:43 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 10/15/2024 at 12:05 PM
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: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, and interview, the licensee did not comply with the section cited above. Licensee left adult #1 with day care children, without proof of fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/15/2024
Plan of Correction
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Licensee will have adult #1 fingerprint cleared and associated before adult #1 works in the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/15/2024 12:43 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 10/15/2024 at 12:32 PM
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: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, and interview, the licensee did not comply with the section cited above. Adult #1 did not have proof of current CPR/First Aid, and day care children were left alone with adult #1, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2024
Plan of Correction
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Licensee shall have proof of CPR/First aid for staff if day care children are left alone with the staff.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024


LIC809 (FAS) - (06/04)
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