103909738-9-9-2019-04-CC-NLOI-BFUPNN-20190909112813

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103909738
Report Date: 09/09/2019
Date Signed: 09/09/2019 11:28:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MARTINEZ ZAVALA, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	103909738
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	09/09/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Sandra Martinez-Zavala		TIME COMPLETED:	11:45 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	Licensing Program Analyst (LPA), Norma Lomeli conducted a capacity increase inspection from a Small Family Child Care Home to a Large Family Child Care Home. Present at time of inspection, Licensee, Sandra Martinez-Zavala and Licensee's Assistant, Eriberto Alvarez who is also her husband. Licensee, her husband, one adult daughter and three minor children reside in the home. Verified licensee, licensee’s assistant’s CPR and First Aid are current. Licensee’s and Licensee’s Assistant certification was completed through Pediatric Plus with EMSA certified stickers and expires on 4/5/2020. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children are background cleared. Fire clearance was granted on July 24, 2019. A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed: Fire clearance was received on August 27, 2019. Licensee states that fire inspector did not require for her to install a fire alarm. LPA observed children size furniture and safe toys books. There were four day care children. Licensee states she does not have weapons, firearms, ammunition or poisons in the home. Facility has a 2A10BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place. There are two small dogs in the home that are kept inside a inaccessible bedroom. Licensee is advised it is her responsibility to ensure the safety of children in care at all times from the pets. Licensee is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present. (Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MARTINEZ ZAVALA, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 103909738
	VISIT DATE: 09/09/2019

NARRATIVE

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Licensee states the home is smoke-free.
Licensee states she does transport day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
Required items are posted in the Child Care Home where parents may easily view.
During visit capacity worksheet was provided and discussed.
Licensee completed the Mandated Reporter Training on September 24, 2018. Licensee’s Assistant completed the Mandated Reporter Training on February 18, 2019.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given licensee.
During today's inspection, LPA inspected the backyard that was previously inaccessible to the day care children. LPA observed a Step 2 picnic table and a sandbox, several tricycles, a Little Tikes toddles slide and balls for the children. There is a gazebo for shade and patio furniture. LPA also observed a large bird cage that is kept locked making the birds inaccessible to day care children. Also observed was a stack of wood logs and containers of recyclable cans and plastic. Licensee agrees to make corrections before backyard can be approved for usage.

LPA & licensee discussed the Community Care Licensing website: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Licensee states her hours of operation are Monday through Friday from 5:00 AM to 6:00 PM and as arranged. Licensee advised she does not provide overnight care, less than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MARTINEZ ZAVALA, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 103909738
	VISIT DATE: 09/09/2019

NARRATIVE

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Licensee is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.

Licensee will remove or cover a stack of wood logs that are located in the backyard.
Licensee will remove a container with recycled cans that have sharp edges and is located in the backyard. This is a potential risk to the health and safety of the children in care.

Pending verification of corrections, the above items and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

LIC809 (FAS) - (06/04)

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