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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212724
Report Date: 01/04/2022
Date Signed: 01/04/2022 02:39:08 PM

Document Has Been Signed on 01/04/2022 02:39 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAMACHO FCC AKA LUPITA'S DAYCAREFACILITY NUMBER:
426212724
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
01/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Maria CamachoTIME COMPLETED:
02:50 PM
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 01/04/2022, at 11:40 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection of the Camacho Family Child Care Home. LPA met with Maria Camacho, Licensee, the purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 2 children in care at the time of the inspection

The main day care areas are day-care room, dining room, kitchen, and bathroom. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the 3 bedrooms and 1 bathrooms secured with locks. The backyard is completely fenced. LPA observed age appropriate toys, bikes, play structure and playhouses LPA observed a small outdoor dog.

No bodies of water were observed. Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. Sampling of children's records were reviewed. The fire extinguisher was observed and was serviced November 3, 2021. There is a functioning carbon monoxide detector and smoke alarm that meets statutory requirements, were tested at 12;02 PM, and functioning at the time of the visit. Licensee is current with immunization required per SB 792. The last Safety drill was conducted August 18, 2021. Licensee CPR and First Aid which expired November 16, 2021. Licensee stated that licensee has enrolled for CPR and First Aid training on February 12, 2022. Licensee provided LPA a copy of receipt at the time of the inspection. Licensee is to submit verification of completion to CCLD by 2/14/2022. A Technical Violation LIC 9102 was issued to Licensee.

CONTINUES ON LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAMACHO FCC AKA LUPITA'S DAYCARE
FACILITY NUMBER: 426212724
VISIT DATE: 01/04/2022
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Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. 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: htttp://www.ada.gov/childqanda.htm

Licensee completed the Mandated Reporter Training on July 1, 2020, that is required per AB 1207. LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep" (PIN 20-24) and Effects of Lead Exposure. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided online at www.ccld.ca.gov.



The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
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