406215446-9-15-2021-17-CC-MKST-C6VTZA-20210915151001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215446
Report Date: 09/15/2021
Date Signed: 09/15/2021 03:10:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	ZEMAITIS FAMILY CHILD CARE		FACILITY NUMBER:	406215446
ADMINISTRATOR:	DANIELLE ZEMAITIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 464-2678
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS: 4	DATE:	09/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	Danielle Zemaits		TIME COMPLETED:	01:30 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	On 9/15/2021 at 12:15pm, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 with Licensee, Danielle Zemaitis. All answers indicated no recent exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee and Assistant wore face coverings. LPA observed the required documents posted inside of the home on the wall adjacent to the front door. There were two (2) children resting on mats in the living room, Licensee was holding an infant and the fourth child's diaper was being changed by the Assistant. Licensee stated that she has been encouraging children over the age of 2 years wear face coverings while indoors. LPA observed the indoor activity area in the playroom which is located past the kitchen. Licensee stated that she has a safety gate that she uses in the playroom to make the kitchen inaccessible while children are indoors. The garage door is made inaccessible by this safety gate or is kept locked. Infants nap in portable cribs in the back bedroom (accessed through the laundry room) and the master bedroom. Licensee stated that she keeps the doors open while infants are napping and that she conducts and documents 15 minute checks of infants under the age of two (2) years while sleeping. LPA observed age appropriate toys, books and child sized tables and chairs. Licensee's school aged children's bedroom is off limits and the door is kept shut during day care hours. Licensee reported that the children are supervised when using the bathroom. The bathroom used by children was observed to be clean and free of toxins. Licensee stated there are no guns or ammunition in the home. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. LPA observed the smoke and carbon monoxide detectors in the hallway at 12:17pm. The 2 A10 BC fire extinguisher has a service date of 6/11/2020. Licensee stated that the fire extinguisher had been serviced in May or June 2021. Licensee will submit a photo to LPA Stewart on or before 9/30/2021 of the proof of service with updated date. Licensee completes and documents emergency drills. The most recent drill was held today, 9/15/21. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ZEMAITIS FAMILY CHILD CARE	FACILITY NUMBER: 406215446
	VISIT DATE: 09/15/2021

NARRATIVE

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The outdoor activity area is accessed via sliding glass doors in the living room. LPA observed the outdoor activity area located on the side of the house which is fenced by a 3 foot fence and a safety gate on the patio. Licensee reported that children are always supervised by an adult while outdoors. There is a cement area, gazebo and small climber with slide on artificial grass. There is a trampoline made inaccessible by a safety gate at the far end of the yard. Licensee stated that the trampoline is not used during day care hours.

Licensee has current Pediatric CPR and first aid expiring on 4/24/2023. Licensee has met SB 792 immunization requirement and completed Mandated Reporter Training per AB 1207 on 9/11/2020. Assistant who started working at the end of July 2021, has a record of negative tuberculosis on file. Licensee will submit Assistant's immunization record and Mandated Reporter Training (per AB1207) on or before 9/30/2021. Facility roster and a sample of children's records were reviewed and found complete.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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: www.ada.gov/childqanda.htm

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP, Individual Infant Sleep Plan (LIC9227) and a sample Infant Sleep Log for 15 minute checks of all children under the age of two (2) years. Licensee reported that the “Effects of Lead Exposure” brochure is distributed to all families at time of enrollment. LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. COVID19 Information for San Luis Obispo County can be found atwww.emergencyslo.org/en/covid19.aspx. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email.

In the areas evaluated today, no deficiencies were cited.

A copy of this report and appeal rights were discussed and left with Licensee, Danielle Zemaitis, whose signature on this form confirm receipt of these documents.

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC809 (FAS) - (06/04)

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