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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419067
Report Date: 01/08/2020
Date Signed: 01/08/2020 01:29:26 PM

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:ZIKA, MARJORIEFACILITY NUMBER:
013419067
ADMINISTRATOR:ZIKA, MARJORIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 371-5621
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:14CENSUS: 9DATE:
01/08/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Marjorie Zika & George Zika IVTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPA) Leslie Ibo arrived at the facility for an unannounced Annual/Random Inspection and met with Licensee Marjorie Zika & finger print cleared husband George Zika IV. Present for this inspection were 2 infants 7 preschool aged children. Also residing in the home is the licensee's fingerprint cleared son George Zika V. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:00 AM – 5:30 PM.

ON LIMITS: two day care rooms with a kitchen, family room, dining area, fenced backyard for children to play
OFF LIMITS: entire second floor, which is separated by a locked door; family room, kitchen, dining area, and garage
ISOLATION: front room of day-care area

The home is two story, which is neat and clean, with heating and ventilation for safety and comfort. There is a swimming pool which is properly gated and inaccessible to children in care. The licensee does not transport children. There were ample age appropriate toys that were observed to be safe and in good condition. Carbon monoxide and smoke detector meet State Fire Marshall standards, working telephone, and first aid kit. There is a 2A10BC fire extinguisher that was fully charged. Per licensee, there are no firearms in the home. All required licensing documents are posted and visible for public review.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: (510) 622-2646
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020
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: ZIKA, MARJORIE
FACILITY NUMBER: 013419067
VISIT DATE: 01/08/2020
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At 12:15, children's files were reviewed and found to be complete. The licensee is in ratio today. Licensee has proof of required immunizations which pertain to child care provider and has current mandated reporter training 3/8/2018. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle. http://www.mandatedreporterca.com/

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.


Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.
NO deficiencies cited today.
This report shall remain on file for 3 years. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.
Exit interview conducted with helper Marjorie Zika. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: (510) 622-2646
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
LIC809 (FAS) - (06/04)
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