013418031-3-13-2025-52-CC-MPRE-DEJULN-20250307144101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418031
Report Date: 03/07/2025
Date Signed: 03/13/2025 05:06:15 PM

Document Has Been Signed on 03/13/2025 05:06 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		FACILITY NUMBER:	013418031
ADMINISTRATOR/ DIRECTOR:	CAMACHO, MIREYA SOSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 512-3759
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 5	CENSUS: 3	DATE:	03/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:32 PM
MET WITH:	Mireya Sosa Camacho		TIME VISIT/ INSPECTION COMPLETED:	02:40 PM

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 3/7/2025 at 12:32pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee’s daughter-in-law, who serves as her helper, for an unannounced annual/random inspection. Present during LPA’s arrival for the inspection was Licensee’s helper, two (2) infants and one (1) preschool age child. Licensee returned at 1:25pm. Licensee lives in the home with her husband, their two (2) minor children, Licensee’s adult son, daughter-in-law, and their infant son. Licensee’s home was toured for a health and safety inspection. The facility operates 6:00am – 5:00pm, Monday – Friday. ON LIMITS AREA: Two (2) playrooms, converted garage (kitchen, bedroom, bathroom and sitting area ), front yard and backyard OFF LIMITS AREA: Main house: primary bedroom and bathroom, three (3) bedrooms, kitchen, living room, one (1) bathroom ISOLATION AREA: Sitting area in converted garage Licensee has requested to place the backyard and the bedroom and bathroom in the converted garage on limits from off-limits. LPA has inspected both areas and has approved the request. The facility is a single-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children’s learning and play. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee provides lunch, dinner and two (2) snacks for the children. All food that may be brought from the children’s home will be properly labeled and stored. Licensee uses child sized tables and chairs for meal times. All materials used for eating was observed to be well maintained, free from defect and in proper working order. Licensee provides sleeping cots and bedding for napping. LPA observed four (4) cribs used for infants. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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 5

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: 03/07/2025

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
26
27
28
29
30
31
32

All cribs were observed to be clean and free from defects. All off-limit areas in the home are made inaccessible with locks. Licensee stated there are no firearms and there are two (2) dogs in the main, off-limit area of the home.

The home has one (1) fully charged 3A40BC fire extinguisher in the playroom closest to the kitchen. There is one (1) working smoke/carbon monoxide detector in each playroom, and an additional working carbon monoxide detector in the playroom closest to the kitchen. The home is equipped with central heat and air for proper ventilation. The front and backyard yards are fully fenced with ample age-appropriate materials for the children. LPA did not observe any harmful bodies of water in or around the home. There are no pools at the home.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid training is complete and expires 10/20/2026. Licensee’s Mandated Reporter training is complete and expires 8/19/2025. Fire/disaster drills have been conducted and documented, with the last drill logged on 12/19/2024. LPA verified all adults living and working in the home have obtained a criminal record clearance. All required forms are currently posted on the sliding glass door leading to the main portion of the home. LPA obtained the children’s files, and facility files. All files were complete.

No deficiencies were cited during LPAs inspection.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
Page 2 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: 03/07/2025

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Mireya Sosoa Camacho, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA discussed the safe sleep regulations with Licensee 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 Licensee 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.

Page 3 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: 03/07/2025

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
26
27
28
29
30
31
32

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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Mireya Sosoa Camacho.

Page 4 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5