192007002-8-24-2021-54-CC-KCHE-C67R9R-20210824124958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192007002
Report Date: 08/24/2021
Date Signed: 08/24/2021 12:50:09 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 CARE		FACILITY NUMBER:	192007002
ADMINISTRATOR:	ZELAYA, BLANCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 778-3723
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 5	DATE:	08/24/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Blanca Zelaya, Licensee		TIME COMPLETED:	01:00 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)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 08/24/2021 at 11:40 AM. LPA conducted COVID-19 Screening Call, prior to entering facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Blanca Zelaya, who guided the LPA on a tour of the facility. Also present were three adults, who live in the home and all have criminal record clearance. There was five day care children present during today’s inspection. Licensee states that there are currently 11 children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 6:00 AM to 6:00 PM, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 06/01/21. This is a single-story home which consists of three bedrooms and two bathrooms, kitchen, living room, and detached garage. Main Care Areas used by the children include the living room, Bathroom 1, Bedroom 1 (used for napping), Kitchen for eating, front yard and side yard with detached garage. Per Licensee, areas off limits to children and parents include Bedroom 2, Bedroom 3, and Bathroom 2, and backyard. Per licensee, off limit areas are also locked during operating hours, LPA observed doors to be locked. 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. Upon entry of the home you walk into Living Room, which Licensee states she will use for isolation area for sick children. At 11:44 AM, LPA observed a wall heater in the living room that is barricaded by a gate, A/C unit in wall in living room, ceiling fan, and a portable A/C unit in Bedroom 1. There is a working telephone maintained in the home. At 11:45 AM, LPA observed Bathroom 1, used by the children down the hallway to the right, to have a diaper changing table, diapers stocked, adequate handwashing supplies, child safety lock on under cabinet sink, and to be free of Report continues- Page 1 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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 4

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: 08/24/2021

NARRATIVE

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hazards. At 11:47 AM, LPA observed Bedroom 1, down the hallway to the left, that will be used for napping to have a wooden Kaplan crib and four blue mats for sleeping. LPA observed a camera in Bedroom 1, and LPA discussed visual supervision for napping for children has to be maintained. At 11:49 AM, LPA observed Kitchen to have child safety locks on all low cabinets, and oven knobs to have child safety covers. 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. At 11:50 AM, LPA observed medicines and knives to be kept in high cabinet in kitchen, making it inaccessible to children in care and detergents and cleaning compounds to be kept under kitchen sink with an operable child safety lock making it inaccessible to children in care at time of inspection. The Licensee does understand that poison must be locked with a key or combination lock. At 11:53 AM, LPA observed side yard area that children will use for daycare activities to have adequate shade, child appropriate tables, chairs, outdoor handwashing station, black cushioning material and turf grass through out, art materials, plastic play kitchen, wooden doll house, and other age appropriate toys free of lose and sharp parts available for children in care at time of inspection. At 11:55 AM, LPA observed detached garage that children will use for more activity space to have books, child size couch, soft play toys, and other age appropriate toys free of lose share parts available for children in care at time of inspection. LPA discussed with Licensee that this detached garage space can only be used for daycare activities and not for eating or sleeping. LPA observed this side yard activity space to be accessible through front door of the home. At 11: 57 AM, LPA observed a locked gate with a sign stating off limits area to the rear backyard, making this area inaccessible to children in care. Per licensee, there are no pets and LPA did not observe any pets.

Per licensee, the children will have access to front yard area for outdoor play. LPA observed front yard has turf grass and adequate shade and perimeter fencing through-out the yard. LPA observed wooden play structure with plastic slide, swings, small plastic climbing/play structure, basketball hoop, outdoor handwashing area, wooden play house, and other age appropriate toys free of loose and sharp parts available for the children in the front yard and all trees, shrubs, and plants are maintained.

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

Report continues- Page 2 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 08/24/2021

NARRATIVE

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The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors are in operable condition. LPA observed First Aid kit is kept hanging on kitchen wall and was inventoried for necessary supplies. 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: 10/2021
—Fire Extinguisher was last serviced on: 06/01/2021
—Mandated Reporter AB1207 Completed: 03/10/2020
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following were discussed:
Incidental Medical Services (IMS)
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

Licensee (or facility representative) 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.

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. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

Report continues- Page 3 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 08/24/2021

NARRATIVE

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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, PIN 21-19-CCP, PIN 20-24-CCP, and LIC 9227.

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 08/24/2021.

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 and report was reviewed with the Licensee, Blanca Zelaya.

Report ends- Page 4 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4