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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216478
Report Date: 03/27/2023
Date Signed: 03/28/2023 11:45:45 AM

Document Has Been Signed on 03/28/2023 11:45 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAMACHO FAMILY CHILD CAREFACILITY NUMBER:
426216478
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/27/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Maricela CamchoTIME COMPLETED:
06:25 PM
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On 03/27/23 at 4:00 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of residence and met with Applicant, Maricela Camacho. LPA informed Applicant of the nature and purpose of the inspection. LPA notes there are no children present during this inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 6AM to 6:00 PM, Monday- Friday. The Applicant also Informed LPA of the intention to provide care for children from birth to 12 years of age. There are three (3) adults that live in the home and all three (3) adults have received criminal record clearance.

LPA toured the interior and exterior of the residence with the Applicant. This is a two-story house that consists of four (4) bedrooms, three (3) bathrooms, living room, dining room, kitchen, garage and outdoor yard. Children will have access to the living room, dining area, one (1) bedroom, one (1) bathroom and outdoor yard. Meanwhile, garage, kitchen and the entire second floor that consists of three (3) bedrooms and two (2) bathrooms will be inaccessible to children in care. LPA observed a baby gate on the first step of the stairway, door safety knob in the garage door and a baby gate making the kitchen inaccessible to children in care.

LPA observed the day-care areas have spacing and ventilation for children in care. In the kitchen, LPA observed that sharps are stored in an elevated cabinet and on top of the refrigerator. LPA observed medication for the family is stored in another elevated cabinet in the kitchen. LPA observed cleaning compounds are stored in the garage and in a closet on the second floor of the home. LPA note all areas are inaccessible to children in care. The bathroom to be used by children was observed to be clean and free of toxins. LPA observed all items, equipment, toys and furnishings are in good conditions and age appropriate.
LPAs observed a required fire extinguisher (2A10BC) in the home which was serviced on 11/22/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. .
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAMACHO FAMILY CHILD CARE
FACILITY NUMBER: 426216478
VISIT DATE: 03/27/2023
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The home has a smoke and carbon monoxide detectors which were tested at 4:45 PM and found to be operable.

LPA and applicant toured the outdoor play area. LPA notes that the outdoor yard is securely fenced. There is plenty of natural shading to afford comfortable to the children. Filtered water will be always accessible to children by means of individual water cups. LPA observed all items, equipment, toys and furnishings to be used outdoors are in good conditions and age appropriate. No bodies of water were observed during inspection.

LPA's record review revealed Applicant completed orientation on 06/30/22. Preventative Health training was completed on 07/29/2022. Further, Applicant completed Mandated Reporter training on 08/08/2022 and Pediatric CPR/First Aid (EMSA approved) on 08/09/2022. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (mortgage deed). Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

LPA reviewed with Applicant 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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 Applicant 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 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.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 3 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAMACHO FAMILY CHILD CARE
FACILITY NUMBER: 426216478
VISIT DATE: 03/27/2023
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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 platform.

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.

Exit interview conducted and report was reviewed with the Applicant, Maricela Camacho. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 03/27/23.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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