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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818193
Report Date: 08/24/2022
Date Signed: 08/24/2022 05:22:21 PM

Document Has Been Signed on 08/24/2022 05:22 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:OCAMPO FAMILY CHILD CAREFACILITY NUMBER:
334818193
ADMINISTRATOR:RICHARD OCAMPOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 755-7036
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
08/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Dorothy Nguyen TIME COMPLETED:
05:30 PM
NARRATIVE
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On 08/24/22, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility on another matter. However, during the tour on a complaint investigation, it was observed that an infant was sleeping in a crib with a blanket as well as a pillow; the crib was located in the day care area of the home. As required by Title 22 Regulations section 102425(b): ..."Cribs or play yards shall be free from all loose articles and objects."

See LIC809D for cited deficiencies in accordance with the California Code of Regulations Title 22, Division 12.

An exit interview was conducted, appeal rights discussed and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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 08/24/2022 05:22 PM - It Cannot Be Edited


Created By: Aman Sharma On 08/24/2022 at 04:51 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: OCAMPO FAMILY CHILD CARE
FACILITY NUMBER: 334818193

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2022
Section Cited
CCR
102425(b)

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Cribs or play yards shall be free from all loose articles and objects.

This requirement was not met as evidenced by:
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LIcensee removed blaket and pillow during the investigation and agrees to read safe sleep PIN and send a written understanding of what safe sleep looks like regarding what is required of a Daycare with infants.
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During the tour on a complaint investigation, it was observed that an infant was sleeping in a crib with a blanket as well as a pillow; the crib was located in the day care area of the home.

This poses an immediate Health and Safety Risk to 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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022


LIC809 (FAS) - (06/04)
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