198400361-3-11-2021-54-CC-RDEO-BYZVMU-20210311153408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400361
Report Date: 03/02/2021
Date Signed: 03/11/2021 03:42:50 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:	198400361
ADMINISTRATOR:	ZELAYA-GARCIA, KARLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 284-9606
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 0	DATE:	03/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Karla Zelaya - applicant		TIME COMPLETED:	02:15 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	Due to COVID – 19 and the Department of Public Health (DPH) guidelines of social distancing, a pre-licensing tele-inspection was conducted via Facetime on 03/02/21 at 1:00 PM. Licensing Program Analyst (LPA) Randy Derraco met with change of location applicant Karla Zelaya via Facetime app. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a 2-bedroom, 1 bathroom, 1 story home with a living room, dining room, laundry area, kitchen and detached two car-garage. The back yard will be used as an outdoor play area and the front yard will be off limits to children in care. Applicant took LPA on a guided tour of home. The entrance to the day care is located to the left side of the home through a pad locked wooden gate. LPA observed a COVID 19 information board, a portable hand washing station, hand sanitizer, disinfectant, a no touch thermometer, and a board designated for required postings upon entering. The main care area is located indoors and outdoors. LPA observed the outdoor main care area to have 3 tables, 3 storage cubbies for toys and art materials. The LPA observed the backyard play area to have a plastic Step 2 brand jungle gym, age appropriate toys, and outdoor play equipment. LPA observed a storage shed made inaccessible by a pad lock and a garage made inaccessible by a locked door. Applicant states both the shed and garage are off limits and are being used for storage. LPA observed a covered chain link fence towards the back of the play area that opens up to an alley. The chain link fence can be locked making the alley inaccessible to the backyard play area. LPA observed a plastic storage chest for additional toys and play equipment in the backyard play area. LPA observed the back entrance to the home that leads to a hallway. An off-limits laundry area was observed on the left with storage cabinets above the washer and dryer. LPA observed child proof locks on the washer and dryer. (Page 1)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ZELAYA FAMILY CHILD CARE	FACILITY NUMBER: 198400361
	VISIT DATE: 03/02/2021

NARRATIVE

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A 2A-10BC fire extinguisher was observed to be fully charged and mounted behind the door without a service tag. Applicant states does not have fire extinguisher receipt. Applicant was advised to provide LPA with a receipt or proof of service. LPA observed the entrance to the kitchen on the right side of the back entrance. LPA observed all cabinets and drawers to have child proof locks. LPA observed cleaning supplies on the window sill above the kitchen sink. Applicant was advised to store cleaning supplies in an inaccessible area. LPA observed the refrigerator and freezer to be clean. Applicant states she will provide food for children in care. LPA observed a wooden chair with a cushion in the corner of the kitchen. Applicant states this area will be used to separate children showing signs of illness. LPA observed a child gate making the off limit living room and off limit dining area inaccessible.

LPA observed a working carbon monoxide / smoke detector in the hallway. LPA observed a doorway on the left leading to a bedroom designated as an indoor main care area. LPA observed a book rack, storage cabinet for toys, a table, 5 foldable sleeping mats, 2 child sized bean bags, 2 child sized chairs and a child sized couch. LPA observed an empty walk- in closet to have a wooden infant baby changing station. LPA observed a 2^nd doorway entrance leading to the bathroom designated for children in care. LPA observed a working toilet and sink to be clean, safe and operable. LPA observed body soap and shampoo bottles stored in the wall above the tub. Cabinets below the sink are observed to have child proof locks making contents inaccessible. LPA observed a 2nd bedroom door with a doorknob cover and a lock making room inaccessible. Applicant indicated 2^nd bedroom is the master bedroom and will be off limits to children in care.

An exit interview was conducted with applicant, Karla Zelaya, and a copy of this report was signed by LPA Randy Derraco. This report will be sent via email to Applicant who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report.

(Page 2)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

LIC809 (FAS) - (06/04)

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