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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700071
Report Date: 10/05/2023
Date Signed: 10/05/2023 03:33:33 PM

Document Has Been Signed on 10/05/2023 03:33 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CAMARGO FAMILY CHILD CAREFACILITY NUMBER:
157700071
ADMINISTRATOR:ANA CAMARGOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 305-9108
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ana CamargoTIME COMPLETED:
01:35 PM
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On 10/05/2023, Licensing Program Analyst (LPA) Beneroso conducted an unannounced Required 1-Year inspection at the Camargo Family Child Care Home. Upon arrival, the LPA met with licensee, Ana Camargo who guided LPA on a tour of the facility. Family members residing in the home include 2adults (licensee and licensee’s spouse) and licensee’s 4 minor children. All adults living in the house have been background cleared. Per the Licensee, hours of operation are a day Monday through Friday 5am – 5pm Per licensee, no overnight care is provided at the moment. Upon arrival, LPA observed 6 day care children in care and the 2 adults providing care and supervision. Licensee is within the ratio for a large facility. Incidental Medical Services (IMS) were discussed.

Physical Plant:
This is a one-story, 4-bedrooms, 2-bathrooms home with a kitchen, living room, dining area, backyard, detached garage, and laundry room. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. During inspection, LPA observed a reciprocating saw in the walkway leading to the main entrance of the day care (Front Yard). A type A Citation was cited for this violation. LPA observed reciprocating saw removed during inspection. The house has central heating and air conditioning. All windows are free of cracks, bugs, and debris. There are no cords hanging from the windows. All electrical outlets are covered.

Main Care Area: Main care is provided in the in the living room and dining area. Children use the bathroom located on the hallway on the right-hand side. LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises. There are cubbies located near the main entrance labeled with children’s names. Per licensee, there is a designated area for ill/sick children in a couch near the main entrance. Children nap in the living room area in mats that are properly stored.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMARGO FAMILY CHILD CARE
FACILITY NUMBER: 157700071
VISIT DATE: 10/05/2023
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Children's bathroom: Children use the bathroom located in the hallway on the right-hand side. The bathroom was clean, sanitized, and in good repair. The bathroom was toured and inspected sink and toilet which is in operable condition. There are shampoos and hair products kept in the bathroom in a lower cabinet, secured with a safety latch.

Kitchen/Dining Room: The kitchen does not have a physical barrier. LPA observed safety latches installed in the cabinets and drawers. Cleaning compounds are stored in a lower cabinet, made inaccessible by safety latches. Per licensee, she does currently have a food program. Meals offered: Breakfast, AM snack and Lunch.

Backyard/Outdoor areas: The backyard is completely fenced (vinyl fence). The backyard has play equipment that is safe and in well repair. The backyard is currently not in use due to licensee doing landscaping work. There is a storage shed that remains locked. Per licensee and LPA’s observations, there are no bodies of water in the premises. There are no pets in the home. There are no

Off-limits: Off-limit areas include all the 4 bedrooms of the home, bathroom #2, garage and laundry room. LPA observed all doors of off-limit bedrooms to have a safety doorknobs.



Care and Supervision: Licensee is within the ratio for a large facility. The Licensee was reminded that supervision is always required for children in care.

Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.


Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (3A40BC) reading in Green and currently serviced. The facility currently does not have childcare insurance. Per licensee, she currently offers transportation. LPA observed vehicle’s valid insurance and driver's license. Per LIS, licensing fees are overdue. Licensee was given her PIN number to make the payment online.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMARGO FAMILY CHILD CARE
FACILITY NUMBER: 157700071
VISIT DATE: 10/05/2023
NARRATIVE
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Medications/ Hazardous Materials: Medications are stored in the master bedroom, made off-limits and secured with a safety doorknob. Cleaning compounds were observed to be kept in a lower cabinet, secured by safety latches. Per licensee, there are No Firearms at the facility.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The Licensee will not be providing IMS to the children at this time.

Records: Children’s records were observed to be incomplete. Two children’s files had Incomplete Consent for Emergency Medical Treatment forms and two infants were missing the Infant Sleep Logs. A type B citation was issued for this deficiency. Assistant’s file was also observed to be incomplete; The Employee Rights Form was missing from the assistant’s file. A type B citation was issued for this deficiency.

Licensee’s CPR/First Aid is maintained current, it expires on 03/01/2024. Mandated was not available during inspection. Per licensee she has misplaced it. Licensee agrees to send proof of completed training no later than 10/06/2023. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 10/05/2023. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and LIC9227 (Individual Sleeping Plan) and Sleep Logs.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe. Applicant was advised that all LIC forms can be found at: www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CAMARGO FAMILY CHILD CARE
FACILITY NUMBER: 157700071
VISIT DATE: 10/05/2023
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Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

Licensee Camargo was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Camargo and discussed the Child Care Licensing Safe Sleep webpage at www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Inspection was conducted in Spanish; LPA is certified bilingual by the department.

The facility was cited 1-Type-A deficiencies as of result of the violations in accordance with Title 22 of the California Code of Regulations and 2-Type B deficiencies. Facility was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of infants currently and newly enrolled at the facility during the next 12 months and facility must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each infant’s file. If these requirements are not met, civil penalties per violation will be assessed.

Exit interview conducted and report was reviewed with the licensee Camargo, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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Document Has Been Signed on 10/05/2023 03:33 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 10/05/2023 at 11:59 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMARGO FAMILY CHILD CARE
FACILITY NUMBER: 157700071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Upon arrival to the facility LPA observed a reciprocating saw in the walk way leading to main entrance (front yard) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2023
Plan of Correction
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LPA observed reciprocating saw being removed during inspection. Deficiency Cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/05/2023 03:33 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 10/05/2023 at 11:59 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CAMARGO FAMILY CHILD CARE
FACILITY NUMBER: 157700071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA observed assistant's file missing Notice of Employee Rights which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2023
Plan of Correction
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Licensee agrees to send proof (pictures) of assistant's complete file, including Employee Rights to LPA Beneroso by 10/19/2023.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in. LPA observed 2 children's files missng the Concent to Emergency Medical Care form which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2023
Plan of Correction
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Licensee agrees to send proof (pictures) of children's complete file, including Concent to Emergency Medical Care to LPA Beneroso by 10/19/2023.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023


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