013419067-11-22-2022-52-CC-SKAR-CLEQM3-20221122111653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419067
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:17:06 AM

Document Has Been Signed on 11/22/2022 11:17 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZIKA, MARJORIE		FACILITY NUMBER:	013419067
ADMINISTRATOR:	ZIKA, MARJORIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 371-5621
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94551
CAPACITY:	14	CENSUS: 8	DATE:	11/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Marjorie Zika		TIME COMPLETED:	11:25 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 November 22, 2022, Licensing Program Analyst (LPA) Simerjit Kaur arrived at the facility to conduct UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION. LPA met with licensee Marjorie Zika. Upon initial arrival there were 2 preschool age children. Present during the inspection 2 infant age children and 4 preschool age children arrived. Present during the inspection was licensee's fingerprint cleared husband George Zika IV, and minor volunteer Archie Darlaston. Also residing in the home is licensee’s daughter Naomi Zika and son George Albert. Zika V. Hours of operation for child care are Monday through Friday, 7:00am to 5:30pm. The facility is a two story house. The following was observed during today’s inspection: CAPACITY: The facility operates as a Family Child Care Home (large), which may have a maximum capacity of twelve (12) to fourteen (14) children. At time of inspection, there were eight children (two infants and four preschoolers), and husband/assistant George Zika, volunteers Archie Darlaston and Naomi Zika. The facility is in compliance with ratio and capacity limitations. ON LIMIT AREAS (accessible to children in care): day care room, second day care with a kitchen, bathroom, fenced backyard for children to play. LPA observed the facility to be clean and in good repair, with heating and ventilation for safety and comfort. There are ample age appropriate toys that are observed to be safe and in good condition. The backyard has a fence surrounding the perimeter of the yard. LPA did not observe any dangerous conditions, nor any hazardous or toxic items accessible to children in the ON Limit areas of the facility today. OFF LIMIT AREAS (not accessible to children in care): entire second floor, which is separated by a locked door; family room, kitchen, dining area, and garage. OFF Limit areas are inaccessible by closed and/or locked doors and visual supervision. Continued on LIC 809C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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: 11/22/2022

NARRATIVE

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Licensee is advised to contact Licensing Department, so that an inspection can be completed prior to changing an OFF Limit area to ON Limit. There is a pool on the premises on the off limit side of the backyard. It was observed that there are no toxins or hazardous items accessible today.

EMERGENCY PREPAREDNESS/SAFETY: Facility has a fully charged 2A10BC fire extinguisher. Smoke and carbon monoxide detectors were tested and found to be functioning. A fire/disaster drill was last conducted on 5/10/2022 and meets the six month requirement. Facility has working telephone service. Per licensee, there are no firearms in the home. Per licensee the Emergency Disaster Plan is current.
STAFF/CHILDREN RECORDS REVIEW: Licensee and all adults living and/or working in the home have proper criminal background clearances. Licensee has current CPR/First Aid training, which expires on 6/25/2024. Licensee’s mandated reporter training completed on 8/27/2022. Licensee is in compliance with immunization law. A facility roster is maintained and a copy obtained.
LICENSING POSTING (required): All REQUIRED forms are posted: Facility license, Notification of Parents’ Rights, Earthquake Preparedness, Emergency Disaster Plan. Licensee was reminded that exersaucers, baby walkers, bouncers, jumpers, and similar items are not allowed and that smoking is prohibited in the home during day care hours.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 LIC 809C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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: 11/22/2022

NARRATIVE

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Licensee was 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 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.

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.

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.o

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

Exit interview conducted and report was reviewed with the licensee Marjorie Zika.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC809 (FAS) - (06/04)

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