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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610469
Report Date: 05/03/2023
Date Signed: 05/17/2023 11:15:11 AM

Document Has Been Signed on 05/17/2023 11:15 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CAMARILLO, IDALIAFACILITY NUMBER:
393610469
ADMINISTRATOR:CAMARILLO, IDALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 922-4993
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
05/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carolyn Boyd and Syana BasilioTIME COMPLETED:
10:30 AM
NARRATIVE
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This is an amended report.
On 05/03/23, Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Idalia Camarillo or a case management inspection. During today's visit the facility was inspected. Upon arrival present at the facility were 9 children in care and two staff. It was revealed during interviews conducted with staff and parents that Staff # 1 violated the personal rights of a daycare child in an incident that occurred on 06/09/2017. Facility failed to report the incident to the Department.

Deficiencies were cited on subsequent page 809D. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 809 D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. Exit interview was conducted. LIC 9224 and Appeal Rights were reviewed and provided to Licensee, Idalia Canmarillo.

A notice of site visit was posted and must remain posted for 30 days.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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 05/03/2023 11:08 AM - It Cannot Be Edited


Created By: Elvira Sierra On 05/03/2023 at 10:02 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CAMARILLO, IDALIA
FACILITY NUMBER: 393610469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2023
Section Cited
CCR
102416.2

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102416.2 Reporting Requirements
(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. This requirement was not met as evidence by;
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POC; Licensee will write an unusual incident report and submitted to LPA by POC due date.
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LPA learned through interviews with staff and parents that an unusual incident took place four years ago in the facility that violated the personal rights of a daycare child and facility failed to report the incident to Licensing. This poses a potential health, safety or personal rights 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:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/03/2023 11:08 AM - It Cannot Be Edited


Created By: Elvira Sierra On 05/03/2023 at 10:03 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CAMARILLO, IDALIA
FACILITY NUMBER: 393610469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/03/2023
Section Cited
CCR
102423(a)(4)

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102423 (a) (4) Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights .....(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions......
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Licensee stated that all staff includingd staff # 1 took a course in behavioral management with chidlren with Resource and referral after the incident.Staff # 1 was spoken to about disciplining kids. Licensee also stated that staff #1 only works at the facility on emergencies assisting as needed.
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This requirement was not met as evidence by: It was revealed during interviews with staff and parents that staff #1 used innapropiate discipline methods with a daycare child. This is an immediate health and safety risk to the children in care.
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Licensee will submit proof of course taken by staff by poc due date.

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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:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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