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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010552
Report Date: 12/31/2024
Date Signed: 12/31/2024 11:47:39 AM

Document Has Been Signed on 12/31/2024 11:47 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CAMPOS, CAMILA & JONATHAN FCCHFACILITY NUMBER:
493010552
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/31/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:58 AM
MET WITH:Camila CamposTIME VISIT/
INSPECTION COMPLETED:
11:51 AM
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A case management visit was conducted by Licensing Program Analyst (LPA) Robert Maciel for the purpose of reviewing changes to the facility's on-limits areas. On 12/27/24, Licensee Camila Campos requested LPA to visit the home to review changes made to on-limits areas of the home. Licensee submitted an updated LIC999 Facility Sketch which shows the garage as off limits and the master bedroom and bedroom 1 on the second floor being on-limits.

During today's inspection, no children were in care. LPA reviewed the new on-limits and off-limits areas with the Licensee. The door to the garage has been made inaccessible via door locks. On the second floor, Licensee stated that both the master bedroom and bedroom 1 will be used for napping only. The upstairs bathroom and bedroom 2 have been marked off-limits and LPA observed that they were made inaccessible by door locks.

LPA also reviewed Infant Safe Sleep regulations, specifically the regulations regarding sleeping on separate floors.

No deficiencies were cited during today's inspection. Report was read and reviewed with Licensee, Camila Campos. A notice of site visit was given and must remain posted for 30 days. Failure to do so will result in an immediate civil penalty of $100.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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