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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628405
Report Date: 10/04/2023
Date Signed: 10/04/2023 12:11:38 PM

Document Has Been Signed on 10/04/2023 12:11 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CAMPOS, LEONARDO & ZAVALA, OFELIA FCCFACILITY NUMBER:
376628405
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/04/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leonardo Campos and Ofelia ZavalaTIME COMPLETED:
11:00 AM
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On October 4th, 2023, at 10:00 AM, Licensing Program Analyst (LPA), Jo Ann Legaspi conducted an unannounced capacity increase inspection. Licensees Leonardo Campos and Ofelia Zavala were advised of the meeting’s purpose and granted LPA facility entry. Present in the home were the Licensees and four (4) children.

On 09/30/2019, the license was granted for a small family childcare home. On 09/01/2023, Licensees submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 09/21/2023 for fourteen (14) children. Landlord Consent is on file.

This one (1) story, three (3) bedroom, two (2) bathroom mobile home was toured and inspected. The following areas are used for childcare: living room, one (1) bedroom, one (1) bathroom and the shaded and fenced backyard. The off limit areas includes the kitchen, dining room, remaining bedrooms and remaining bathroom. A child safety gate barricades access into the kitchen and dining room. Kitchen cabinets also have sliding cabinet locks. Doorknob child safety covers are on the doorknobs to the off limits bedrooms and bathroom.

Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. First Aid and CPR certifications expire in October 2023. Licensees showed LPA written documentation that they are enrolled to recertify their First Aide and CPR certifications on 10/06/2023. Facility has working 2A10BC fire extinguisher, smoke alarms, carbon monoxide, and the first aid kit in place. The last safety drill was on 06/09/2023. There is a pool on the grounds of the mobile home park, but the Licensees state daycare children do not use this pool. Per the Licensee, no weapons or ammunition are housed in the facility. The daycare schedule is weekdays 6 AM to 6 PM.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CAMPOS, LEONARDO & ZAVALA, OFELIA FCC
FACILITY NUMBER: 376628405
VISIT DATE: 10/04/2023
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The Licensees have provided proof of control of property. Because the licensees rents/leases the location space, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the licensees confirm was provided to the property owner/landlord. The licensees obtained a signed Property Owner/Landlord Consent form (LIC 9149).

The Licensees were provided with the Ratio/Capacity Worksheet for a large family childcare home. The Licensees acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensees shall comply with the capacity requirements for a Small Family Child Care Home.

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 platforms. 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.

In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) of children is approved today (10/04/2023). A new license will be generated and mailed to the provider.

A notice of site visit was given to the licensees and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Licensees Leonardo Campos and Ofelia Zavala.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
LIC809 (FAS) - (06/04)
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