198401059-4-25-2024-54-CC-KCHE-D4NSHS-20240425135402

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198401059
Report Date: 04/25/2024
Date Signed: 04/25/2024 01:54:10 PM

Document Has Been Signed on 04/25/2024 01:54 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CAMPOS FAMILY CHILD CARE		FACILITY NUMBER:	198401059
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/25/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:20 PM
MET WITH:	Keylee Campos, Applicant		TIME VISIT/ INSPECTION COMPLETED:	02:20 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 04/25/2024 at 12:30 PM, Licensing Program Analysts (LPAs) Katrina Chicote and Claudia Kam conducted an Announced – Prelicensing Inspection to the above facility. Upon arrival, LPAs met with Applicant, Keylee Campos, who granted entry to facility and guided the LPAs on a tour of the facility both indoors and outdoors, including off limits areas. Adults in the home were discussed and all have criminal record clearance. The Applicant is requesting a small family child care home license max capacity of 8 (has landlord consent on file). Per Applicant, operation hours will be Monday thru Saturday 5:00 AM to 10:00 PM caring for children 0-12+ years of age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home that consists of two bedrooms, 1.5 bathrooms, Day Care Room 1, Day Care Room 2, Living Room, Kitchen, and Dining Room. Per Applicant and Facility Sketch submitted, the children will have access to Day Care Room 1 (located upon entry of the home), Day Care Room 2 (located to the left room upon entry), and Half Bathroom (located to the rear of the home). Per Applicant and Facility Sketch submitted, off limit areas of the home will be Living Room, Bedrooms 1 & 2, Full Bathroom, Dining Room, and Kitchen. At 12:32 PM, LPAs observed operable baby gates making these areas off limits at time of inspection. Per Applicant, children will only use Living Room and Dining Room to access half bathroom and children will have full supervision and escorted when children need to use restroom. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPAs observed central heat and Applicant states she will have windows open and obtain fans for air. LPAs observed facility has numerous windows that were open allowing for ample ventilation at time of inspection. There is a working telephone maintained in the home. At 12:35 PM, LPAs observed Day Care Room 1 to have chid size tables and chairs available well maintained and cubbies for children's belongings. LPAs observed shelves with baskets filled with a variety of age appropriate toys such as soft plush toys, musical instruments, and dramatic play equipment that were free of loose and sharp parts at time of inspection. At 12:38 PM, LPAs observed Day Report Continues - Page 1 of 5

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198401059
	VISIT DATE: 04/25/2024

NARRATIVE

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Care Room 2 that Applicant states will be used for quiet play and napping. LPAs observed standard blue cots and one wooden crib all maintained at time of inspection. LPAs observed child size half circle table and chairs in Day Care Room 2. Applicant states they will also Day Care Room 2 as an isolation area for sick children. LPAs observed electrical cover outlets all through the home. Applicant states she will provide food to children in care and use Day Care Room 1 for eating. At 12:40 PM, LPAs observed half bathroom to have adequate supplies, operable equipment, and general safety and sanitation. LPAs observed operable child safety lock on under cabinet sink at time of inspection. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 12:42 PM, LPAs observed these items stored in a closet with operable child safety lock in the off limits laundry area in the back of the home. Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the age, size, and abilities of children in care. LPAs advised that poisons used to kill any kind of bugs/vermin should be locked with a key or combination lock to be inaccessible for a variety of children's size, age, and abilities.

Per Applicant, the children will have access to front yard for outdoor play. At 12:50 PM, LPAs observed front yard has grass, concrete pathways, and adequate perimeter fencing through-out. LPAs observed all trees, shrubs, and plants are maintained at time of inspection.

LPAs did not observe any pets at time of inspection and Applicant confirms she has no pets. Per Applicant, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.

At 12:52 PM, LPAs observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with proof of purchase receipt for 04/16/2024. LPAs tested smoke and carbon monoxide detectors and observed to be in operable condition at time of inspection. LPAs observed First Aid kit stored hanging by entrance in Day Care Room 1 and was inventoried for supplies. The Applicant has current Pediatric First Aid and CPR valid until 06/2025 and required AB1207 Mandated Reporter training completed on 03/15/2024. Proof of immunization against influenza, pertussis, and measles were readily available during today’s inspection.

The following was discussed with the Applicant:
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
Report Continues - Page 2 of 5

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198401059
	VISIT DATE: 04/25/2024

NARRATIVE

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· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department for a minimum of 3 years.
· No infant walkers, No Johnny jumpers, No saucer chairs, No incline sleepers or any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.
· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.
· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com
Report Continues - Page 3 of 5

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198401059
	VISIT DATE: 04/25/2024

NARRATIVE

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Incidental Medical Services (IMS):
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. 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 discussed the safe sleep regulations with Applicant 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 Applicant 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.

LPA advised the Applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the Applicant. Forms referenced on LIC 311D were provided to Applicant during this inspection.

OTHER INFORMATION AND FORMS PROVIDED:
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.
· Handout for Lead poisoning

The Applicant provided proof of control of property.
Because the Applicant rents/leases the home, proof of landlord notification is required. The LPAs observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Report Continues - Page 4 of 5

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 198401059
	VISIT DATE: 04/25/2024

NARRATIVE

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

On this date, 04/25/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information: https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Per Applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The Applicant was advised that email may be public information.

Based on LPA's observation today, 04/25/2024, Applicant will be approved to operate a small family child care home license (max capacity 8). The Applicant is required to comply with the terms and limitations stated on the license.

Exit interview was conducted and report was reviewed with the Applicant, Keylee Campos.
Report Ends - Page 5 of 5

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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