013418031-5-22-2019-52-CC-LDYN-BCEPMR-20190522112645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418031
Report Date: 05/22/2019
Date Signed: 05/22/2019 11:26:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CAMACHO, MIREYA SOSA		FACILITY NUMBER:	013418031
ADMINISTRATOR:	CAMACHO, MIREYA SOSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 512-3759
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY:	14	CENSUS: 5	DATE:	05/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Mireya Sosa Camacho		TIME COMPLETED:	11:35 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/22/19 at 9:45am, Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with the licensee. The licensee's fingerprint cleared spouse/assistant J. Briseno, 2 infants and 3 preschool aged children were also present. At 9:50am, LPA requested and reviewed the files of 2 children in care. LPA reviewed the following documents: CPR/first aid certificates for both the licensee and her spouse which are current and expire on 10/27/20, the licensee's mandated reporter training certificate dated 10/20/18 and the current facility roster. A copy of the roster was obtained. At 10:10am, LPA toured the areas of the home that are used for the child care, to conduct a health and safety inspection. The areas used for the child care include: the converted garage which has a bedroom, bathroom, eat-in kitchen, and the play room and the room next to the converted garage, which was an addition to the home that has been converted to a child care room. The off limit areas are all of the areas in the main section of the home, which are made inaccessible by closed and/or locked doors and visual supervision. The isolation area is the lounge section next to the kitchen, away from other children in care. The outdoor play area is the fenced front yard, which LPA observed is free from defects or dangerous conditions. LPA observed an ample supply of toys and activities, which are age appropriate and in good condition. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, fully stocked first aid kit and telephone. There are no heaters or fireplace accessible to children. All required forms are posted and visible for public review. Per the licensee, there are no firearms in the home. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy. continued on 809C

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CAMACHO, MIREYA SOSA	FACILITY NUMBER: 013418031
	VISIT DATE: 05/22/2019

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted with the licensee.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019

LIC809 (FAS) - (06/04)

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