343622474-5-13-2024-03-CC-JVEO-D58N35-20240513100547

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622474
Report Date: 05/13/2024
Date Signed: 05/13/2024 10:05:54 AM

Document Has Been Signed on 05/13/2024 10:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	ZAUCHA, JAMILA & ZAUCHA, RUSSELL		FACILITY NUMBER:	343622474
ADMINISTRATOR:	ZAUCHA, JAMILA & ZAUCHA, R		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 402-5269
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	14; 14	CENSUS: 4	DATE:	05/13/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jamila Zaucha		TIME COMPLETED:	10:15 AM

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Licensing Program Analyst (LPA) Soleil Marx and LPA Jennifer Velasco met with Facility Representative, Licensee Jamila Zaucha (Licensee), for an unannounced inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Facility hours of operation are Monday through Thursday, 7:30 AM to 5:30 PM.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

A health and safety inspection was conducted in the areas accessible to children. Off limit areas include: Garage, laundry room, and main bedroom and bathroom. Licensee understands that children may never enter off-limits areas. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a 2A10BC fire extinguisher within the home. LPA observed the home was safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys. Licensee stated there are no firearms or bodies of water on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock.

LPA observed all required postings, a children's roster and fire drill log. LPA reviewed records of children’s files and staff files, all of which contained the required documentation. Licensee has current EMSA-approved pediatric CPR/First Aid and Mandated Reporter certifications. Licensee understands both CPR and Mandated Reporter training must be completed every two years.

LPA reviewed with Licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ZAUCHA, JAMILA & ZAUCHA, RUSSELL	FACILITY NUMBER: 343622474
	VISIT DATE: 05/13/2024

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LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No Title 22 deficiencies are being cited based on today's inspection. Exit interview conducted and report was reviewed with Licensee Jamila Zaucha. During the exit interview, Licensee Jamila Zaucha confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

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