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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620125
Report Date: 07/26/2021
Date Signed: 07/26/2021 02:37:42 PM

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:ZAMORA, DIANAFACILITY NUMBER:
393620125
ADMINISTRATOR:ZAMORA, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 923-2329
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:14CENSUS: 9DATE:
07/26/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Diana ZamoraTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Chris Jackson conducted an unannounced inspection. LPA met with licensee Diana Zamora The purpose of the inspection is to conduct a case management inspection to inspect the licensee’s new above ground swimming pool. Upon arrival there were nine children present in the home with the licensee and their assistant.

LPA inspected the above ground pool in the backyard. The pool is surrounded with a see through mesh fencing. The pool fencing also incorporates the homes existing wooden fence line towards the rear of the pool area. LPA observed the pool fencing is five feet height. Although the fencing is secure, LPA observed the fencing was not equipped with a self-closing, and self-latching gate that is located no more than six inches from the top of the gate and swings away from the body of water. Licensee stated the self closing and self latching gate can be installed within a two week time frame. In addition licensee stated the backyard will remain off limits to children in care. A follow up inspection will be conducted with licensee upon completion of the fencing.

LPA conducted an exit interview. Based upon today’s inspection, no Title 22 deficiency was cited. Notice of Site visit provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
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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