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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846332
Report Date: 05/03/2024
Date Signed: 05/03/2024 11:16:49 AM

Document Has Been Signed on 05/03/2024 11:16 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CAMARENA FAMILY CHILD CAREFACILITY NUMBER:
334846332
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:04 AM
MET WITH:Yadira Camarena, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 05/03/2024 at 8:04 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. In addition, the LPA conducted follow-up for alterations to the physical plant. On 12/14/2023 the licensee notified the department that construction began in the kitchen and a 2nd notification was submitted on 02/13/2024 when the construction was completed. LPA was greeted by Licensee Yadira Camarena and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: Present were the licensee and 2 adult residents. The licensee updated the LIC279 Application days and hours of operation. The licensee updated the LIC999A Home sketch for off-limit areas and agrees to submit a 2nd Home sketch for the 2nd level of the home, which was not on file.

Normal days and hours of operation: Monday – Friday, 6:00 AM to 6:30 PM
OFF-LIMIT AREAS INCLUDE: Kitchen, Laundry Room, Garage, Bonus Room, Entire 2nd Floor and Side Yard designated as a dog run

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains.
· The facility is operating within the licensed capacity and appropriate ratios. LPA took a census of 2 children in care.
· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
· A working telephone is present.
· Appropriate fire extinguisher (2A:10BC), smoke detector and carbon monoxide detector are present and were tested by the licensee during this inspection on 05/03/2024.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CAMARENA FAMILY CHILD CARE
FACILITY NUMBER: 334846332
VISIT DATE: 05/03/2024
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· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children.
· Storage of poisons are inaccessible to children and are locked.
· Stairs are barricaded on 05/03/2024.
· The fireplace is properly screened on 05/03/2024.
· No guns or weapons present as stated by the Licensee Yadira Camarena. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present.
· Verification of control of property on file by mortgage statement.
· Property owner/landlord notification and consent on file.
· Pediatric CPR and First Aid training: 08/28/2022; Card expires on 08/2024.
· Health & Safety Certificate - completed on 09/25/2022.
· Mandated reporter General: 11/2022; AB 1207 Child Care Expires: 11/2024
· Fire clearance: 12/28/2022, however the application for a large license was withdrawn.
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 01/09/2024.
· There are no bodies of water on 05/03/2024, and the licensee Yadira Camarena understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children’s files are complete.
· Staff’s files are complete.
· A review of staff records on 05/03/2024 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CAMARENA FAMILY CHILD CARE
FACILITY NUMBER: 334846332
VISIT DATE: 05/03/2024
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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.

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 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: http://www.ada.gov/childqanda.htm

Licensee Yadira Camarena, 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 Susan Brewer, discussed the safe sleep regulations with licensee Yadira Camarena 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 Y. Camarena, 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.

The Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CAMARENA FAMILY CHILD CARE
FACILITY NUMBER: 334846332
VISIT DATE: 05/03/2024
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

No deficiencies were issued on today’s date.

No civil penalties issued on today’s date.

A Notice of Site visit was given and must remain posted for 30 days. LPA S. Brewer, verified the Notice of Site Visit was posted prior to leaving the facility.

Exit interview conducted and report was reviewed with the licensee Yadira Camarena.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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