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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622474
Report Date: 09/20/2019
Date Signed: 09/20/2019 12:27:54 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ZAUCHA, JAMILA & ZAUCHA, RUSSELLFACILITY NUMBER:
343622474
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
09/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jamila ZauchaTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Kelly Ferrara met with Licensee Jamila Zaucha for an unannounced random annual inspection of her small family child care home. All adults who live in the home have obtained a criminal record clearance and the annual fees are current. Hours of operation are Monday through Friday 7:15 AM- 5:30 PM. Licensee stated that on Tuesday and Wednesday, she takes one child with her to pick up her children from school and is not home until 2 PM. There were three children present during the inspection.

A health and safety inspection was conducted in all areas accessible to children. Off limit areas include: Master bedroom and bathroom, garage, and laundry room. LPA observed a working phone, 2A10BC fire extinguisher, screened fireplace, first aid kit, and functioning smoke and carbon monoxide detectors that meet regulations. LPA observed a current children's roster and fire drill log with the last drill conducted in August 2019. Knives, medications, and chemicals were all stored inaccessible to children. LPA did not observe any bodies of water on the premises and Licensee stated there are no firearms or weapons in the home.

LPA conducted a file review for the Licensee and children in care. The Licensee has proof of immunizations for herself and husband and proof of Mandated Reporter training. LPA advised that this must be completed every two years. Licensee has a valid CPR/First Aid certificate which expires in October 2019. LPA advised the Licensee to enroll in a new course to stay in compliance. LPA observed that all of the required documentation was present in each child's file. Licensee has child care liability insurance.

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.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ZAUCHA, JAMILA & ZAUCHA, RUSSELL
FACILITY NUMBER: 343622474
VISIT DATE: 09/20/2019
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Effects of lead exposure information was given to the Licensee. The facility evaluation report was reviewed and discussed. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request. Notice of site visit was provided and it must remain posted for 30 days for parental review.

No deficiencies were cited based on today's inspection.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
LIC809 (FAS) - (06/04)
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