414004926-8-12-2022-05-CC-HLEG-CH92GY-20220812172354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004926
Report Date: 08/12/2022
Date Signed: 08/12/2022 05:24:06 PM

Document Has Been Signed on 08/12/2022 05:24 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CAMPOS, LIDIANA & CAMPOS, OLEANDRO		FACILITY NUMBER:	414004926
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	08/12/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Lidiana and Oleandro Campos		TIME COMPLETED:	05:23 PM

NARRATIVE

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On 8/12/2022, Licensing Program Analyst (LPA), Hanson Leong, conducted a scheduled, pre-licensing inspection with the applicants, Oleandro and Lidiana Campos. LPA were granted entry by the applicants. LPA explained to the applicants about the purpose of the visit. All the facility's staff members have had their criminal background checks cleared by Guardian. Hours of operation are from Monday to Friday, 8:00 am to 5:00 pm.

Applicants rent the home. Before children enroll, the applicants state that they will purchase liability insurance for her home day care. Applicants plan to care for children ranging in age from four months to five years old. .

Day care area(s): Entire downstairs, Bathroom and Backyard

Off-limits area(s): Garage, and Entire Upstairs. Applicant are aware off-limits areas are not to be used during business hours

Both LPA and the applicants conducted a health and safety inspection of the home. The house is clean and safe, with a working smoke and carbon monoxide detector and a fully charged fire extinguisher. The Applicants are equipped with a fully stocked First Aid Kit as well as a thermometer. There are no bodies of water in the residence. The Applicants have garbage cans with tightly fitting covered lids. At the home, the children in care have access to age-appropriate toys and equipment. The Applicants were reminded by the LPA that baby walkers, bouncers, jumpers, and similar items should not be used on children in care.

Applicants have a designated cell phone and is aware that it must be kept in the home during day care hours. According to the applicants, there are no firearms or weapons in the home. The side of the home will be the isolation area for a sick child. All hazardous materials and toxins are kept out of children's reach and are inaccessible. Applicants intend to serve food to the children. The applicants will provide cribs and resting mats for the children while they are napping. *** See Page 2 for continuation***

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CAMPOS, LIDIANA & CAMPOS, OLEANDRO	FACILITY NUMBER: 414004926
	VISIT DATE: 08/12/2022

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Continued, Page 2
LPA reminded the applicants that the CPR and First Aid training must be renewed every two years. Applicants has proof of immunization and has completed the Mandatory Reporter Training. LPA reminded that the Mandated Reporter Training must be renewed every two years.

LPA informed the applicants that emergency disaster drills should be conducted at least once every six months and that the date and time of the drill should be recorded. If applicants provide care to the seventh and eighth child, who must be school aged, parent notification and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

LPA discussed the safe sleep regulations with applicants 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. LPAs also informed applicant 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

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. Applicant was advised all assistants, volunteers, frequent visitors or adults living in the home, over the age of 18 must be fingerprint cleared, associated to the home and have proof of immunization, prior to having any contact with the children in care. Failure to do so could result in an immediate civil penalty of $100 per person, each day. ***See Page 3 for continuation***

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CAMPOS, LIDIANA & CAMPOS, OLEANDRO	FACILITY NUMBER: 414004926
	VISIT DATE: 08/12/2022

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Following the pre-licensing inspection, LPA will recommend to the applicant a Small Family Day Care Home License if the following conditions are met, pictures must be submitted to the department for review.
1. Cribs and Resting Mats
2. Safety gate or net surrounding the bottom portion of the bouncer in the backyard
3. A safety gate, at least 5 ft tall covering the entrance to the washer and dryer.

Applicants were advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available Mon-Fri, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing.

A copy of the report was provided to the applicant

An exit interview was conducted, and the report was reviewed with the applicant, Oleandro Campos

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

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