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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214149
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:08:23 PM

Document Has Been Signed on 11/02/2022 12:08 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 FAMILY CHILD CAREFACILITY NUMBER:
406214149
ADMINISTRATOR:BERTHA A. CAMACHOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 238-5261
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Bertha CamachoTIME COMPLETED:
12:22 PM
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On November 2, 2022 at 10:35 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with Licensee Bertha Camacho and advised her the purpose of the inspection. Licensee provided LPA a tour of the home. There was five (5) children in care at the time of the inspection. This report was verbally translated in Spanish for licensee using Language Link services.

Licensee uses the living room, kitchen, one (1) bathroom, and backyard for children in care. LPA observed a fireplace in the living room with a screen secured with a child lock preventing children from having access. LPA observed the smoke and carbon monoxide detectors. Detectors were not tested at the time of the inspection because children were sleeping. Licensee stores their cleaners and disinfectants in the garage. LPA oberved the garage door was secured preventing children from having access. Knives are stored in a top cabinet inaccessible to children. LPA observed a serviced 2A10BC fire extinguisher mounted on the wall in the living room with a service date of 7/28/22. Licensee had age appropriate toys and accessories readily accessible for children in care. The backyard is enclosed with a fence preventing children from wandering away. LPA observed enough space and shade available. Licensee has age appropriate toys and accessories readily accessible for children in care. LPA observed an enclosure secured for licensee's dogs.

LPA reviewed a sampling of children and staff records. The children and staff records were found to be current and complete. Facility does not have any children requiring incidental medical services (IMS). Facility staff met the requirements for CPR/First-Aid. Licensee's Mandated Reporter expired on 10/30/2022. A technical violation will be cited for the Mandated Reporter since it was just recently expired.

No deficiencies were cited during today's inspection.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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 FAMILY CHILD CARE
FACILITY NUMBER: 406214149
VISIT DATE: 11/02/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

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/process.

Licensee 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 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 [facility representative] 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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