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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701195
Report Date: 12/18/2025
Date Signed: 12/18/2025 10:55:59 AM

Document Has Been Signed on 12/18/2025 10:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CAMPOS, GLORIAFACILITY NUMBER:
015701195
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/18/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Gloria CamposTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On December 18th, 2025, at approximately 9:10am, Licensing Program Analyst (LPA) April Wright met with licensee Gloria Campos for the purpose of a Capacity Increase Inspection. There were no adult individuals or children present during today's inspection. The home was toured for health and safety inspection. Hours of operation are 6:00am to 6:00pm Monday through Friday.

The single story home consists of three bedrooms, two bathrooms, Living/Dining area, kitchen, front yard, side yard, rear yard and 2-car garage. The home is neat and orderly with heating and ventilation for safety and comfort of children in care. There are age appropriate toys for the children to utilize. LPA observed and Licensee confirmed that there are no pools, hot tubs or any bodies of water present in the home. LPA observed and Licensee confirmed that there are no hazardous materials, including cleaning products, medicines or toxins visibly present or accessible to children in care during the inspection. The home has a fully charged 3A40BC fire extinguisher and dual smoke/carbon monoxide detectors and first aid kit. LPA observed and Licensee confirmed that there are no pets in the home. Licensee confirmed and LPA observed that there are no weapons or firearms of any kind present in the home or on the premises. LPA advised and Licensee understands their responsibilities and to inform CCLD if any firearms are purchased or brought into the home. On Limits: The day care areas will consist of Living Room, Dining area, Kitchen, hallway bathroom and rear yard. The isolation area for sick children is a section of the dining area at the small children's table which is away from children in care.
Off Limits: All three bedrooms, second bathroom(inside bedroom #1 to the right of hallway) front and side yard and garage. Per San Leandro Fire clearance, children are not permitted in the garage. Licensee understands and acknowledges their responsibility to ensure that children never eat or sleep in the garage at any time. There is a chimney located in the living room(to left of entry to the home), which is barricaded to prevent access when children are in care. Per the licensee, the chimney is not in use at any time. The off limits areas are and will be made inaccessible by closed and/or locked doors and visual supervision. See LIC809C for continuance.
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: April Wright
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CAMPOS, GLORIA
FACILITY NUMBER: 015701195
VISIT DATE: 12/18/2025
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 The licensee has current Mandated reporter training which was completed on 8/2/2024 and CPR/First aid certificate which expires on 8/2027. Licensee also completed their Preventative Health and Safety Training on 10/25/2024. All required forms are posted and visible for public review upon entry to the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. Licensee was reminded that training certificates must be renewed every 2 years.

Capacity Increase: All requested/required documents were received for the increase in capacity application and verified by the LPA on 12/11/2025. The fire clearance for a capacity of fourteen (14) children was approved by the San Leandro Fire Department and received by CCLD via email on 12/9/2025. The Licensee is reminded to abide by the conditions of the fire clearance which states that day care is not permitted in the garage. Pull down fire alarm is located in Day care room (living room) on the right side of the wall above the couch. The licensee was reminded that an assistant must be present at ALL times when there is more than eight (8) children in attendance. Whenever the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. A copy of Capacity Requirements for a Family Child Care Homes (small and large) were reviewed and given to licensee. Licensee understands the capacity requirements for family child care homes.

Assistant Requirements: LPA discussed with licensee the requirements and documents required for an assistant to be working and present with children in care. LPA advised licensee to have completed and received all documents prior to the assistants first day of employment in the family child care home. When the licensee has an assistant, the licensee will ensure that the assistant has the following documents and placed in a personnel file for review: 1) Mandated Reporter certificate for Child Care Providers (AB1207), 2) Criminal Record Clearance and associated to the facility (Guardian), 3) Proof of immunization against Measles (MMR) & Pertussis (Tdap), 4) Proof of TB Clearance, & 5) Signed copy of the Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) Form. CPR & First Aide is required if the assistant is left alone with the children.

Licensee Gloria Campos Family Child Care home is recommended for an increase of capacity of up to 14 children as of 12/18/2025.

A notice of site visit of given was given and must be posted for 30 days. Exit interview was conducted and report was reviewed with the licensee Gloria Campos.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: April Wright
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC809 (FAS) - (06/04)
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