073404483-10-11-2019-02-CC-CACA-BGUUZZ-20191011160222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073404483
Report Date: 10/11/2019
Date Signed: 10/11/2019 04:02:27 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZEPEDA, MIRIAM		FACILITY NUMBER:	073404483
ADMINISTRATOR:	ZEPEDA, MIRIAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 516-3948
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 8	DATE:	10/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Miriam Zepeda		TIME COMPLETED:	04:15 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	Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced ANNUAL/RANDOM inspection. Present during today’s inspection was the licensee, her fingerprint cleared husband, fingerprint cleared son, two infants, two school aged children and four preschool aged children in care. Licensee's husband is also her assistant. The home was toured for Health and Safety Inspection. On limits area consist of the living room, dinning room, family room, kitchen, master bedroom and the backyard (center and right side only). Off limits area consists of he entire second floor, the laundry room, master bathroom, garage, and the left side of the backyard. The home was observed to be orderly, with heating and ventilation for safety and comfort. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. Stairs are gated. The home has a gas fire place that is not used during child care hours as stated by the licensee. LPA verified that the fire extinguisher 3A40BC is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced. The licensee was reminded that children are not to be left in parked vehicles. The licensee is operating within the licensed capacity. LPA did not observe any child left without supervision during the inspection. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

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: ZEPEDA, MIRIAM	FACILITY NUMBER: 073404483
	VISIT DATE: 10/11/2019

NARRATIVE

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Children files were reviewed. Files reviewed contain children’s emergency information. The licensee has current CPR and First Aid which expires 10/18/20. Licensee completed mandated reporter training 1/9/18. Richard Zepeda completed mandated reporter training 2/15/18. Licensee is in compliance with immunization requirements.

Fire and disaster drills are conducted at least once every six months.

The licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Information on safe sleep was provided and discussed with the licensee.

There are no deficiencies cited during today’s inspection.
Exit interview was conducted with Miriam Zepeda.
Licensee was provided a copy of the appeal rights.
Notice of Site visit was provided at the time of inspection and must be posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

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