073403445-9-8-2022-02-CC-MSUN-CJ3UQD-20220908154659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073403445
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:47:06 PM

Document Has Been Signed on 09/08/2022 03:47 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZAVALA, KAREN		FACILITY NUMBER:	073403445
ADMINISTRATOR:	ZAVALA, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 252-1485
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	14	CENSUS: 16	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Karen Zavala		TIME COMPLETED:	03:50 PM

NARRATIVE

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On 9/8/22 at 1:15 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection at Karen Zavala Large Family Childcare Home. LPA met with Karen Zavala and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family Childcare Home days and hours are Monday to Friday 6:00 AM to 6:00 PM. Present in the home at time of inspection were 16 preschool children, licensee, licensee's son and assistant.

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.

Indoor Space: A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A40BC fire extinguisher, smoke alarm (hardwired through the burglar alarm system) and carbon monoxide detector in the home. The home is a one story consisting of 4 bedrooms, 2 bathrooms, living room, eat-in kitchen, family room, preschool room located in the backyard with bathroom and garage.

The OFF-LIMIT area is garage, which is inaccessible to children in care by closed locked doors and visual supervision. IN-USE The family room, living room, kitchen, backyard, 4 bedrooms, 3 bathrooms, preschool room and preschool room bathroom is used as the primary areas for day-care. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and draws with latches. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are 3 dogs and no arms and ammunition stored in the home. The fireplace is screened, and the home maintains a working telephone.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZAVALA, KAREN	FACILITY NUMBER: 073403445
	VISIT DATE: 09/08/2022

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Outdoor Space: LPA toured the outdoor area (backyard) and observed it was fenced. Play structure and toys are age appropriate. LPA discussed with licensee that there needs to be supervision when children are outside playing when playing with water.

Children files and Facility files were reviewed. LPA did not conduct staff interview.

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

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.

Due to the issuance of a Type A citation during today's inspection, a copy of this Licensing Report must be posted in the facility and given to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Karen Zavala.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/08/2022 03:47 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZAVALA, KAREN	FACILITY NUMBER: 073403445
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(a)

Staffing Ratio and Capacity

(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above due to having 16 children in care which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	By 9/922 Licensee will submit a written statement understanding the regulation and ratios for a Large Family Child care home.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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