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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493995
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:20:48 PM


Document Has Been Signed on 05/01/2024 01:20 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:OCAMPO & PANDIANI FAMILY CHILD CAREFACILITY NUMBER:
197493995
ADMINISTRATOR:OCAMPO, A & PANDIANI, DFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 349-9075
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:12CENSUS: 8DATE:
05/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:AMIE OCAMPO, LICENSEETIME COMPLETED:
01:30 PM
NARRATIVE
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On 05/01/2024 Licensing Program Analyst (LPA) Lisa Clayton arrived at the CCC unannounced, to conduct a Case Management inspection regarding an Unusual Incident Report received at the EL Segundo Regional Office on 04/30/2024. Upon arrival LPA met with Licensee Aime Ocampo. LPA Clayton observed 9 children being supervised and cared for by Licensee and fingerprint cleared staff.

On 05/01/2024, Licensing Program Analyst (LPA) Lisa Clayton conducted an unannounced Case Management – Incident inspection related to a self-reported Unusual Incident Report (UIR) submitted on 04/30/2024. Upon arrival, LPA met with Licensee Aime Ocampo, and explained the purpose of the visit. LPA observed 8 children in care, being supervised and care for appropriately by Licensee and a fingerprint cleared assistant.

According to the UIR, The child’s father brought him to daycare on Thursday 04/25/2024 and licensee observed scratches on the childs forehead, tip of his nose and under his chin. Licensee asked the father what happened to the child, and the father said C1 fell off of the couch.

At breakfast, the assistant asked C1’s older sister (C2) what happened to C1 and the C2 said “daddy hit him”.

Assistant Judith told licensee what C2 told her, and licensee went to talk to C2 and asked C2 what happened to C1’s face and C2 said “daddy hit him”. Licensee states she asked C2 how daddy hit C1 and C2 said “ with his hand”. Licensee said she asked C2 why and she (C2) started talking about something else, so licensee didn’t ask her about it anymore.

Licensee reported that she provides care to 3 of the Fogelstrom children (2 year old twins C1 and C3, and 3 year old C2). LPA Clayton observed C2 and C3 in care today. C1 was last at the FCCH on Friday April 26, 2024.



Licensee reported the incident to the DCFS on yesterday 04/30/2024.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 05/01/2024 01:20 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: OCAMPO & PANDIANI FAMILY CHILD CARE
FACILITY NUMBER: 197493995

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2024
Section Cited
CCR
102416.2(a)(c)(1)

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(a)The licensee shall report the following information the Department by telephone or fax......... (c) In addition to the events specified in Health and Safety Code Sections 1597.467(b)(1)(A) ………, the licensee shall report the following events to the Department: (1) Any suspected child abuse or neglect, as defined in Penal Code Section 11165.6, of any child in care, in addition to reporting requirements pursuant to Penal Code Section 11166.
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LPA Clayton reminded licensee and staff of the importance of reporting incidents to the Department and other Departments as necessary, in addition to completing and submitting the Unusual Incident Form (LIC624B) to the department in the time frame and indicated on the form.
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This requirement was not met as evidenced as licensee did not call and report the incident of suspected abuse to the Department within 24 hours as specified in the regulations, which poses an immediate Health & Safety risk to children in care.
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Licensee acknowldeges understanding and ensures that she will call all departments as needed and LIC 624B forms will be completed and submitted to the department as incidents occur.

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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: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: OCAMPO & PANDIANI FAMILY CHILD CARE
FACILITY NUMBER: 197493995
VISIT DATE: 05/01/2024
NARRATIVE
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During today’s inspection, LPA toured the indoor and outdoor of the home, reviewed the Title 22 Regulation regarding Reporting Requirements and attempted to interviewed C2.

Per Title 22 Regulations and Health and Safety Codes, Deficiencies were cited today (see LIC 809-D).

An exit interview was conducted. A copy of this report (LIC 809) and Notice of Site Visit were provided to Licensee Aime, and must remain posted for 30 days.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC809 (FAS) - (06/04)
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