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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216337
Report Date: 03/16/2023
Date Signed: 03/16/2023 11:36:08 AM

Document Has Been Signed on 03/16/2023 11:36 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAMACHO FAMILY CHILD CAREFACILITY NUMBER:
426216337
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adela CamachoTIME COMPLETED:
11:40 AM
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On 03/16/23, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Case Management inspection of the above referenced Family Child Care Home (FCCH) for a change of capacity. LPA met with Adela Camacho, Licensee of the FCCH and explained the nature/purpose of the inspection. LPA notes there is one (1) child on site, being supervised by Licensee.

During this inspection, LPA and Licensee together toured the interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit, which would pose a danger to the children in care. LPA observed sharps are stored in an elevated cabinet in the kitchen that is locked. Medication in the home is stored in the bedrooms of the home that are inaccessible to children in care. LPA observed cleaning compounds are stored under the sink in the kitchen that is locked and in an elevated cabinet in the laundry room that is also locked.

LPA reviewed the Licensee’s First Aid/ CPR certification which expires on 01/04/2025. LPA reviewed the Licensee’s Mandated Reporter Training certificate, which expires on 12/9/2023. LPA observed a regulation fire extinguisher which was purchased on 05/01/2022.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). Licensee submitted work verification experience from previous employer. The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 03/08/2023.

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective today. Effective date of license is today March 16, 2023.



Exit interview was conducted with Licensee, Adela Camacho. Licensee was provided with a Notice of Site Visit (LIC 9213) to be posted for the next 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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