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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198401059
Report Date: 03/24/2026
Date Signed: 03/24/2026 03:33:38 PM

Document Has Been Signed on 03/24/2026 03:33 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 CAREFACILITY NUMBER:
198401059
ADMINISTRATOR/
DIRECTOR:		CAMPOS, KEYLEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 382-0349
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 2DATE:
03/24/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Licensee Keylee CamposTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 03/24/2026 at 10:20 AM, Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced annual/ random inspection at the above facility . Upon arrival, LPA met with Licensee, Keylee Campos, who granted LPA entry into facility. LPA discussed the purpose of today's visit.

Upon arrival LPA observed 2 adults present (Licensee and staff assistant) with 2 children present (no infants currently enrolled) playing in the gated front yard. Adults in the home were noted and discussed, and all have criminal record clearance. LPA conducted on a tour of the facility both indoors and outdoors, including off limits areas. The facility is licensed for a Large Family Day Care with a Capacity of 14. Per Licensee, operation hours are Monday - Saturday 5:00 AM to 10:00 PM and cares for children 0-12+ years of age. Per Licensee stated overnight care is not provided. LPA Calderon informed Licensee per Title 22 regulations "Overnight Care" means care being provided to children anytime between the hours of 6 p.m. and 6 a.m. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care. Therefore, due to this regulation overnight care is provided as facility is open until 10pm per hours of operation.

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 three bedrooms (1 used for day care), 1.5 bathrooms, living room (divided into 2 sections), kitchen, dining room, backyard and garage.
On limits: bedroom #1 ( relaxing room / day care room, located upon entry of the home), part of the living room (located to the left room upon entry), half bathroom (located to the rear of the home), and front yard. Off limit areas: 1/2 of the living room, bedroom #2 and #3, full bathroom, dining room, kitchen, laundry room, back yard, and garage. Per Licensee, the following areas are only to be used as passage ways to the 1/2 bathroom: 1/2 of the living room (near the kitchen), kitchen/ dining room and laundry room; the children have full supervision and are escorted when children need to use restroom. (Page 1 out of 5)
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2026
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 8
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 8
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: 03/24/2026
NARRATIVE
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LPA observed operable baby gates making off limit areas inaccessible to the children in care. All areas identified on the facility sketch accessible to children were inspected to ensure that they are clean, orderly, free of hazardous items and with ventilation and heating for the safety of the children. Per interview with Licensee and per LPA Calderon observation facility uses portable A/C system, portable fans and windows are open for ventilation LPA observed central heating system on ceilings inaccessible to children. Bedroom #1 per Licensee is mainly used for quiet/relaxing time and napping. LPA observed blue cots for children in care and one wooden crib for infants when in care. LPA observed the firm mattress and LPA observed a purple fitted sheet that is appropriate to the mattress size of the crib, although, fabric that overlaps the underside of the mattress was dislodging fabric, picture taken. Due to no infants enrolled, LPA gave consultation informing Licensee on regulation: Infant Safe Sleep Section 102425(a)(3) -Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. LPA Calderon observed age appropriate materials, equipment, and materials for children to use. For an isolation area for children who are observed sick and waiting to be picked up by authorized representative, Licensee will use whichever on limits bedroom #1 or half of the living room that is not in use by non sick children. In the dining room area, LPA observed two drawers with safety clips, the cabinet to the left hand side had office supplies and sharp push pins, drawers are inaccessibility to the children. The kitchen was observed Licensee stated the children are provided food LPA observed food being given to the children. LPA reminded Licensee if children bring food from home to ensure food items are labeled with children's names and properly stored. In the kitchen LPA observed the cabinets under kitchen sink to have a safety latch in place for inaccessibility to the children in care; this area had items that are hazardous to children- knives and cleaning supplies.

LPA observed half bathroom to have adequate supplies, operable equipment, and general safety and sanitation. LPA observed operable child safety lock on under cabinet sink at time of inspection, this area was observed and contains paper toilet. In the laundry room area, there were cabinets with safety latches, that cabinets were observed by LPA Calderon at 10:49am, to have detergents, additional cleaning compounds, and one poison bottle Spectracide Bug Stop Home Barrier spray bottle in the closet in the laundry room, pictures taken. Licensee per interview, informed LPA Calderon stores poisons in the locked garage and during the visit LPA Calderon asked Licensee to store the poison found in the laundry room in a locked area, Licensee placed it immediately in the garage and deficiency cited and cleared during this visit.
(2 out of 5)
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: 03/24/2026
NARRATIVE
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Licensee was advised that inaccessibility of hazards items must be constantly reassessed depending on the age of children enrolled, and abilities of children in care.

LPA observed a non functional fire place used for storage items in the off limits partial living room (used for passage way only) and Licensee confirmed, during visit Licensee and wrote a Declaration Letter LIC855 and provided it to LPA regarding non operable fireplace. Although, fireplace is non operable LPA observed a barricaded fence in front of the fireplace, it was not secured to the wall / mantle area, consultation was given to secure barricaded gate for the safety of the children since the children pass by in this area and needs to remain inaccessible. In the off limit section of the living room LPA observed a car seat not in use, LPA reminded Licensee car seats are to be used for transportation only.

LPA observed the front yard that is used for outdoor play. LPA observed front yard has grass, concrete pathways, and adequate perimeter fencing through-out. Per Licensee Campos informed LPA that the left runner space and a section of the right side yard space to the right of the home is off limits to the children in care and children are supervised at all times and do not access the off limit areas. Upon LPA Calderon's review of the Facility Sketch LIC999A consultation was given to update the sketch Floor Plan and Yard Plan and for them to indicate, front yard (sections marked off limits), back yard, garage and measurements of each room. LPA observed front and back yard and LPA observed no bodies of water on premises.

LPA did not observe any pets at time of inspection, per Licensee confirmed there are no pets. Per Licensee, there are no weapons / firearms stored in the home, no transportation is provided, and no children currently being administered medication at the facility. LPA Calderon did not observe on premises any firearms/weapons at time of inspection. LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged, Licensee stated went to get it inspected but was not provided with a service tag and no proof of documentation that it was bought or serviced within 1 year was provided to LPA Calderon, picture taken of fire extinguisher at 2:32pm, deficiency cited. LPA tested smoke located in living room, found operable and carbon monoxide detector in the children's bedroom, found in operable condition at time of inspection. LPA observed in the living room wall by the children's bedroom the required postages to be posted in a prominent area - PUB394 Notification of Parent's Rights and Facility License. LPA provide Earthquake Preparedness form LIC9148 during visit and informed Licensee must be maintained posted. (3 out of 5)
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: 03/24/2026
NARRATIVE
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LPA Calderon reviewed files for the two children present and the Licensee and staff assistants (staff #1- S1) file. The Licensee has current Pediatric First Aid and CPR valid until 5/31/27. LPA reviewed Licensee Mandated Reporter training that expired on 3/15/26, picture taken, deficiency cited. At 1:17pm, Licensee reviewed Staff #1 (S1) American Heart Association First Aid and CPR certification, certification for First Aid indicates adult and not pediatric, and CPR portion indicates Child and Infant, this certification per LPA Calderon's review is invalid as it does not indicate Pediatric for the First Aid section, picture of certificate taken. At 1:22pm LPA Calderon reviewed S1 Immunization records for S1's immunization records, records indicated Tuberculosis -TB only, and missing Measles and Pertussis ( MMR & TDAP/ DTAP) Records. In addition, missing LIC9108 Statement Acknowledging Requirement to report Child Abuse. S1 had Employee Rights form, Mandated Reporter training Child Care Providers expires 3/17/28 and Personnel record / ID in file. Deficiency cited for Personnel Records for missing/incomplete documents for S1. Two children files reviewed, consultation was provided via checklist provided LIC126 and LIC311D Records document sent to Licensee to review to complete children records efficiently. At 2:25pm LPA informed Licensee K.Campos of the Technical Support Program for training regarding regulations, Licensee K.Campos would like to join program and obtain more information.

LPA reviewed Disaster/ Fire Log, last date conducted based on document provided was on 3/2/2026. LPA Calderon reviewed Children's Roster LIC9040 which was current and updated and observed with the total of 5 children enrolled at the facility.
  • To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
  • Licensee was reminded that all adults 18 and over living or working in the home, 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.

(4 out of 5)
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: 03/24/2026
NARRATIVE
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  • LPA discussed the safe sleep regulations with Licensee 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.
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
  • Licensee informed of the MyChildCarePlan.org website; 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.
  • During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.


Per California Code of Regulation Title 22, 4 Type B deficiencies were given during this visit. 1 out of 4 deficiencies were cleared during this visit. LPA Calderon generated Plan of Correction letter and provided letter to Licensee K.Campos. Appeal Rights were given and an exit interview was conducted with Licensee Keylee Campos.

(5 out of 5)

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 03/24/2026 03:33 PM - It Cannot Be Edited


Created By: Ashley Calderon On 03/24/2026 at 02:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198401059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon observation of the fire extinguisher the valve on the required 2A 10BC fire extinguisher indicates fully charged, Licensee stated went to get it inspected but was not provided with a service, no proof of documentation that it was bought or serviced within 1 year was provided to LPA Calderon, picture taken of fire extinguisher, the licensee did not comply with the section cited above in [1] out of [1] item that does not meet State Fire Marshall Regulations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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Licensee during visit called company where they alleged to get fire extinguisher inspected, and they stated she will have to go back to get a service tag. Therefore, Licensee stated will get a service tag and will send a photo to LPA Calderon by POC due date.
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation in the laundry room area, there were cabinets with safety latches, that cabinets were observed by LPA Calderon at 10:49am, to have detergents, additional cleaning compounds, and one poison bottle Spectracide Bug Stop Home Barrier spray bottle in the closet in the laundry room, pictures taken, the licensee did not comply with the section cited above in [1] out of [1] Bug Killer poison bottle which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2026
Plan of Correction
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Licensee per interview, informed LPA Calderon stores poisons in the locked garage and during the visit LPA Calderon asked Licensee to store the poison found in the laundry room in a locked area, Licensee placed it immediately in the garage
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2026


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 03/24/2026 03:33 PM - It Cannot Be Edited


Created By: Ashley Calderon On 03/24/2026 at 02:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 198401059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon record review Licensee Keylee Campos Mandated Reporter training certificate expired on 3/15/26, the licensee did not comply with the section cited above in [1] out of [2] expired staff mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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Licensee will conduct mandated reporter training, link sent via cell phone. Licensee will conduct Child Care Provider- 4 hr training and send picture of certification to LPA Calderon by poc due date.
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon obseration fro record review for Staff #1 (staff assistant) was missing Measles and Pertussis ( MMR & TDAP/ DTAP) Records and missing LIC9108 Statement Acknowledging Requirement to report Child Abuse, incomplete American Heart Association First Aid and CPR certification, certification for First Aid indicates adult and not pediatric, and CPR portion indicates Child and Infant, this certification per LPA Calderon's review is invalid as it does not indicate Pediatric for the First Aid section, the licensee did not comply with the section cited above in [1] out of [1] incomplete staff assistant records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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Licensee will provide staff assistant - Staff #1 Valid Pedaitric 1st aid portion to conduct or re do CPR/1st aid certiciate. LIC9108 Statement Acknowledging Requirement to report Child Abuse to fill out/ sign and Licensee will to obtain Staff #1 immunization records for Measles and Pertussis ( MMR & TDAP/ DTAP) and either obtain record for Flu or get have staff #1 write a letter to decline Flu only and records will be sent to LPA Calderon by poc due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2026


LIC809 (FAS) - (06/04)
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