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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418031
Report Date: 11/01/2022
Date Signed: 11/01/2022 01:46:21 PM


Document Has Been Signed on 11/01/2022 01:46 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:CAMACHO, MIREYA SOSA & DIAZ, YOLANDA DUENASFACILITY NUMBER:
013418031
ADMINISTRATOR:CAMACHO, MIREYA SOSA &FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 512-3759
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:14CENSUS: 6DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Yolanda Diaz & Mireya CamachoTIME COMPLETED:
01:44 PM
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On 11/1/2022 at 10:37am Licensing Program Analyst (LPA) Morgan Pringle met with Licensees Mireya Sosa Camacho and Yolanda Duenas Diaz for an Unannounced Annual Inspection. Present during the inspection was the Licensees, three (3) infants and three (3) preschool age children. Licensee Diaz is the daughter in-law of Licensee Camacho. Licensee’s live in the home with J. Briseno Sosa (Diaz’s husband and Camacho’s son), J. Briseno (Diaz’s father in-law and Camacho’s husband), G. Briseno Sosa (Diaz’s brother in-law and Camacho’s son). The facility currently operates 6:00am – 5:00pm, Monday – Friday.

ON LIMITS AREA: Two (2) Playrooms, Converted Garage (consists of a kitchen, bedroom and bathroom), Master Bedroom and Bathroom next to playroom and Front Yard
OFF LIMITS AREA: Main House: Three (3) bedrooms, Kitchen, Living Room, one (1) bathroom and backyard
ISOLATION AREA: Bedroom in the converted garage

The facility is a single-story home owned by Licensee Camacho. The inside and outside of the home was observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensees provide all food for the children in care. Any food brought from the children’s home will be properly stored and labeled.

The home has one (1) fully charged 3A40BC fire extinguisher in the playroom closest to the kitchen. There is one (1) working smoke detector in each playroom and a working carbon monoxide detector in the playroom closest to the kitchen. The home is equipped with central heat and air for proper ventilation. LPA did not observe any harmful bodies of water in or around the home. Licensees stated there are no firearms in the home. There are seven (7) dogs in the home. Licensee Camacho stated three (3) of the seven (7) dogs are puppies and will be out of the home by Friday, 11/4/2022, leaving (2) adult dogs and two (2) puppies.
Continued on LIC809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CAMACHO, MIREYA SOSA & DIAZ, YOLANDA DUENAS
FACILITY NUMBER: 013418031
VISIT DATE: 11/01/2022
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Licensees are operating within the licensed capacity and is in ratio. Both Licensees ’s Health and Safety training has been completed. Both Licensees ’s Pediatric CPR and First Aid training is complete and expires 10/10/2024. Licensee Camacho’s Mandated Reporter training is complete and expires 6/2/2023. Licensee Diaz’s Mandated Reporter training is complete and expires 6/7/2023. Fire and disaster drill log is complete with last drill logged 10/6/2022. All required postings are made visible by the door that leads to the main house. LPA obtained the facility roster, facility files and children’s files. All files were complete.

Licensees were reminded that California Law requires Licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensees that all forms can be downloaded at www.ccld.ca.gov. Licensees were also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensees were reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensees were reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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.

Continued on LIC809-C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
Page: 2 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CAMACHO, MIREYA SOSA & DIAZ, YOLANDA DUENAS
FACILITY NUMBER: 013418031
VISIT DATE: 11/01/2022
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Licensees were reminded that all adults 18 and over living or working in the home, 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 Licensees 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 Licensees 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with Licensees Mireya Camacho and Yolanda Diaz.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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