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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304200821
Report Date: 11/21/2023
Date Signed: 11/21/2023 11:51:59 AM

Document Has Been Signed on 11/21/2023 11:51 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CAMACHO, ALEYDAFACILITY NUMBER:
304200821
ADMINISTRATOR:CAMACHO, ALEYDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 547-7199
CITY:RANCHO STA MARGARITASTATE: CAZIP CODE:
92688
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee, Aleyda Camacho TIME COMPLETED:
12:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Aiddee Nunez created a case management report, during a complaint investigation it was discovered that on June 22, 2023, the Orange County Sherriff’s Department (OCSD) arrived at the licensee’s home to conduct an investigation. There are no records of the licensee contacting Community Care Licensing Department reporting the OCSD visit.

LPA Nunez reviewed the Unusual Incident (LIC 624) and Reporting Requirements with licensee.

Based on record reviewed the following deficiency was discussed and cited. The facility was not in compliance with the California Code of Regulations, Title 22, Division 12, 102416.2 (b)(3)(C) Reporting Requirements: "A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events: Any unusual incident that threatens the physical or emotional health or safety of any child." Please refer to 809D for details of deficiency.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee, Aleyda Camacho was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

End of Report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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Document Has Been Signed on 11/21/2023 11:51 AM - It Cannot Be Edited


Created By: Aiddee Nunez On 11/21/2023 at 10:35 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAMACHO, ALEYDA
FACILITY NUMBER: 304200821

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2023
Section Cited
CCR
102416.2(b)(3)(C)

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102416.2 (b)(3)(C) Reporting Requirements: "A report shall be made to the Department…following the occurrence
during the operation of a family day care home of any of the following events: Any unusual incident that threatens the
physical or emotional health or safety of any child."
This requirement is not met as evidence by:
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Licensee will notify Licensing office if there is an unusual incident report within 24 hours. Licensee will also provide a written statement by the POC date via email to the LPA.
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Based on record review, the licensee failed to report the OCSD arrived at the facility on 6/22/23 to conduct an investigation about a daycare child was inappropriately touched and interacted while in care to licensing office within 24 hours. This poses a potential Health and Safety risk to the children in care.
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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:Thuy Ho
LICENSING EVALUATOR NAME:Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
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