197494255-3-11-2025-58-CC-ECAO-DENVK9-20250311162958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494255
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:30:12 PM

Document Has Been Signed on 03/11/2025 04:30 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SELVA DE CAMPOS FAMILY CHILD CARE		FACILITY NUMBER:	197494255
ADMINISTRATOR/ DIRECTOR:	SELVA DE CAMPOS, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 384-8133
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	03/11/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Rosa Selva De Campos, Licensee		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/05/2025, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Required Annual inspection at 16761 Lassen Street, North Hills, CA. 91343. LPA arrived at the facility at 02:00 PM, identified self and met with Rosa Selva De Campos, Licensee and Alejandrina Campos, Assistant who guided analyst on a tour of the inside and outside of the facility. There were 7 children upon arrival. LPA provided Licensee with a copy of the LIC126 Entrance Checklist -Family Child Care Homes to help facilitate the inspection. Licensee cares for children from ages 0 months to 13 year-olds. Facility hours of operation are Monday to Friday from 07:30AM to 05:30PM. The licensee provided proof of control of property. The family child care home is a one-story dwelling, includes combination living / dining room, kitchen, 2 bedrooms, 3 bathrooms, laundry nook, children’s classroom, children’s sleeping room, and no garage. There is a front yard that is off limits to children. There is a fenced outdoor play area and a swimming pool in the back of the house. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The children use the children’s class room for child care activities and eating. There are tables and chairs, toys and play items that are safe, clean, and appropriate for the ages of the children. The children’s sleeping room is used for napping. LPA observed there are cribs, mats, and bed linens available for children. The children use the bathroom #1 located in the children’s sleeping room. There is a vanity cabinet that holds hand soap and paper products, and no hazards were observed. LPA observed that the bathroom that children use was safe and sanitary. PAGE 1 OF 6

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SELVA DE CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197494255
	VISIT DATE: 03/11/2025

NARRATIVE

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Per Licensee, when a child shows signs of illness they will be separated from other children and isolated in the children’s classroom or children’s sleeping room whichever one is available away from the other children.

The kitchen is made inaccessible with the use of a child proof door knob and a door lock to the only entrance. The licensee provides food for children in care. Licensee stated when food is brought to the facility it is labeled with child’s name and stored properly.

There is telephone service via a cellphone. LPA informed Licensee that the cellphone must remain in the facility during the hours of operations.

The outdoor play area is located at the back yard of the house, is fenced and there are no hazards to children present. LPA observed appropriate toys, and other play equipment for children in care. The outdoor play yard is covered with cement. Children have access to a climbing structure. LPA observed adequate shade with a covered patio.

LPA observed a pool (photos taken), the fenced is in good repair, completely surrounds the pool, is designed and installed so children could not remove any portion, is at least 5 feet high, is constructed so that it does not obscure the pool from view. Children cannot easily climb over the fence, there is no window or door with direct access. The gate swings away from the pool, self closes, is self-latching, and the self-latching device is located no more than 6 inches from the top. There are no gaps more than 4 inches, and the bottom of the fence is no more than 4 inches from the ground. Additional safety requirements include: a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard, a rescue pole with a body hook and minimum fixed length of 12 feet and a pool alarm that will sound upon detecting an entrance into the water and must be turned on and be in working condition during the FCCH’s operating hours while the swimming pool is not in use. LPA observed that the alarm meets the ASTM International Standard F2208.

LPA observed that the Licensee performs a daily inspection of their drowning prevention safety features and safety equipment before opening the facility, and they maintain a log of the inspections that was readily available and provided to the department upon request.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SELVA DE CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197494255
	VISIT DATE: 03/11/2025

NARRATIVE

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Per Licensee, areas off limits to children and parents include combination living / dining room, kitchen, 2 bedrooms, 2 bathroom, laundry nook, and are made inaccessible by use of door locks to the only entrance to those areas.

LPA did observe a front yard, per Licensee, the front yard is not used for child care activities and is used for dropping off and picking up children. Children enter the child care through the front gate to enter the children’s classroom or the back yard children will enter facility through the back-alley entrance gate.

Per Licensee, there are no firearms, ammunition, or poisons on the premises. LPA did not observe any firearms, ammunition, or poisons during the inspection. Poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children.

Per Licensee, there are one (1) dog on the premises and per Licensee during the hours of operations the dog is kept in a fenced area on the side yard of the house away from children.

LPA did observe a fireplace located in the combination living/dining room. The fireplace is made inaccessible with the use of a child proof door knob and door lock to the only entrance. LPA did not observe an open face heater during the inspection. There is a working fire extinguisher, the valve on the required 2A 10BC fire extinguisher indicates fully charged and Licensee confirmed last service date was 02/25/2025. There is a combination smoke and carbon monoxide detector in the children’s room that was tested and is operable.

There are currently four (4) infants enrolled at the facility. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SELVA DE CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197494255
	VISIT DATE: 03/11/2025

NARRATIVE

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LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats shall only be used for transportation purposes and shall not be used for sleeping.

Capacity as specified on the license is being maintained.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA reviewed a sample of children’s files and observed files were complete and documented on the LIC857.

An emergency fire/disaster drill has been completed and documented within the last 6 months on 02/14/2025. Licensee’s Mandated Reporter Training was completed on 10/2023. Licensee’s pediatric CPR/First Aid expires on 10/2025.

There were one (1) personnel record for LPA to review and LPA found the personnel record was complete.

LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and information to be posted.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SELVA DE CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197494255
	VISIT DATE: 03/11/2025

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SELVA DE CAMPOS FAMILY CHILD CARE	FACILITY NUMBER: 197494255
	VISIT DATE: 03/11/2025

NARRATIVE

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During today's visit, in accordance with the California Code of Regulations, Title 22, Division 12, Chapter 3, there were no deficiencies cited.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Rosa Selva De Campos, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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