Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417613
Report Date: 10/21/2015
Date Signed 10/21/2015 11:07:16 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:CAMPOS FAMILY CHILD CAREFACILITY NUMBER:
197417613
ADMINISTRATOR:CAMPOS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 263-0534
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:14CENSUS: 3DATE:
10/21/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Maria CamposTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Joanne Alcala conducted an annual random visit at the above facility. Upon arrival LPA was greeted by licensee, Maria Campos. LPA observed 3 children present. One preschooler and two infants. Per Licensing Information System (LIS) all adults residing and working in the home have obtained background clearances. Per LIS, facility annual fees are current. The licensee is operating within proper capacity and ratios. LPA Alcala observed licensee to be present at the home and providing adequate care and supervision.

The home is clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and Carbon Monoxide, fully charged 2A10BC fire extinguisher and working telephone. There are several age appropriate toys and a first aid kit on the premises. Knives and medications are in accessible to children. Kitchen and bathroom areas were inspected for inaccessibility of toxins/cleaning compounds and other potentially dangerous objects/materials. Electrical outlets around the home were properly covered. The detach garage is off limits as well. The backyard is completely fenced in. There are no bodies of water in the FCCH. The back yard is clean and free from any debris. Per the licensee, there are no firearms on the premises. The licensee has current CPR and first aid that expires 6/20/17.

SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) -33-4313
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2015
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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