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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192007002
Report Date: 02/12/2020
Date Signed: 02/12/2020 03:13:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ZELAYA FAMILY CHILD CAREFACILITY NUMBER:
192007002
ADMINISTRATOR:ZELAYA, BLANCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 778-3723
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:14CENSUS: 6DATE:
02/12/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Blanca Zelaya, LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs)Katrina Chicote and Denise Gibbs conducted an unannounced Random Annual inspection to the above facility on 02/12/2020 at 1:05 PM. Upon arrival, LPAs met with Licensee Blanca Zelaya who guided the LPAs on a tour of the facility. Also present was S1 Licensee's husband, who is also the assistant. Per Licensee, 3 adults live in the home. There were 6 napping children present during today’s inspection. Licensee states that there are currently 10 children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 7:00 AM to 5:30 PM. Emergency Disaster Plan, License, and Parent's Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 1/9/2020.

This is a single story home which consists of 3 bedrooms and 2 bathrooms, kitchen/eating area, living room, den, front yard, back covered patio, back yard, and detached garage. Main care areas used by the children include the living room, kitchen used primarily for eating, 1 bedroom used for napping, bathroom in the hallway, front yard, back covered patio, and detached garage. LPAs advised Licensee that detached garage can only be used for day care activities and not for sleeping or eating. Per Licensee, areas off limits to children and parents include back yard, 2 bedrooms, and 1 bathroom inside Licensee's bedroom. Per licensee, off limit areas are locked during operating hours, LPAs observed doors to be locked and signs posted on bedroom doors stating off limit areas.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPAs observed air conditioning units and wall heater that is barricaded. There is a working telephone maintained in the home. LPAs observed age appropriate toys, free of loose and sharp parts. Per Licensee, there are no pets and LPAs did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. Report continues- Page 1 of 3
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ZELAYA FAMILY CHILD CARE
FACILITY NUMBER: 192007002
VISIT DATE: 02/12/2020
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Per Licensee, the children will have access to front yard and back covered patio area for outdoor play. LPAs observed age appropriate toys free of loose and sharp parts available for the children in the outdoor play area. LPAs observed play structures, perimeter fencing and turf grass all through the outdoor play area.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care.

Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors are in operable condition. LPAs observed First Aid kit in kitchen. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 11/2020
—Fire Extinguisher was last serviced on: 03/20/2019
—Mandated Reporter AB1207 Completed: 03/09/2018

The following were discussed:
Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

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


Report continues- Page 2 of 3
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ZELAYA FAMILY CHILD CARE
FACILITY NUMBER: 192007002
VISIT DATE: 02/12/2020
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The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep was provided as well as the Lead handout.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 2/12/2020.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted with Licensee Blanca Zelaya, copy of this report was given and appeal rights were issued and discussed.


Report ends- Page 3 of 3
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3