406215446-7-6-2023-17-CC-DMWT-CTGSLW-20230706135902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215446
Report Date: 07/06/2023
Date Signed: 07/06/2023 01:59:11 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/06/2023 01:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 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: 9	DATE:	07/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Daniell Zemaitis		TIME COMPLETED:	02:10 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 07/06/23, at 11:45 AM, Licensing Program Analyst (LPA) Dixie Wright conducted an unannounced Required Comprehensive Annual inspection of this Family Child Care Home (FCCH). LPA met with Danielle Zemaitis, Licensee, and toured the interior and exterior of the FCCH. The living room, dining room, hallway bathroom, back room off of the kitchen and part of the backyard are used for child care, while the remainder of the home is excluded. LPA observed nine children on site, (four are infants) along with one assistant, (cleared and associated). LPA observed required licensing forms and documents posted on the wall in the entryway. LPA observed a combination smoke and carbon monoxide detector in the hallway near the bathroom, which was tested at 12:03 PM and functioning. The FCCH has a regulation fire extinguisher, serviced on 07/16/2023. Licensee is aware to either service or purchase a regulation fire extinguisher annually. Last fire drill was done 02/15/2023. LPA observed age appropriate toys, furniture and equipment in the FCCH's interior. LPA observed the restroom used by children to be clean and free of toxins. Medications/vitamins are stored in an elevated cabinet in the kitchen, inaccessible to children. LPA observed cleaning compounds in an elevated cabinet in the kitchen, and in the laundry room in an elevated cabinet, inaccessible to children. Sharps in the FCCH are stored elevated in the kitchen inaccessible to children. The backyard is enclosed by wooden fencing and the footing in the area is cement and artificial turf. Toys and play equipment observed on site are age appropriate. The fence’s entry/exit gate is secure. LPA observed no bodies of water on site. Children's records were reviewed. The records are current, complete and possessed emergency contact information as well as immunization records. LPA also reviewed documentation noting (CONT. LIC 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ZEMAITIS FAMILY CHILD CARE	FACILITY NUMBER: 406215446
	VISIT DATE: 07/06/2023

NARRATIVE

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the infant's sleep checks have been conducted in 15 minute intervals forl infants in care. Facility roster for children in care is current. The Licensee's records were also reviewed. Pediatric CPR and First Aid (EMSA approved) expires on 04/22/2025. Licensee is enrolled in Mandated Reporter training. Licensee stated no firearms or ammunition is stored on site.

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.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. 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, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ZEMAITIS FAMILY CHILD CARE	FACILITY NUMBER: 406215446
	VISIT DATE: 07/06/2023

NARRATIVE

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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.

During the exit interview, Licensee Daniell Zemaitis, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights given.

Exit interview conducted and report was reviewed with the licensee Licensee Danielle Zemaitis.

See deficiency cited on attached 809-D

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/06/2023 01:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ZEMAITIS FAMILY CHILD CARE	FACILITY NUMBER: 406215446
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/14/2023 Section Cited HSC 1597.622(a)(1)	1 2 3 4 5 6 7	§1597.622-Employees or volunteers at family day care home; immunization requirements; records; exemptions(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis and	1 2 3 4 5 6 7	Per Licensee, she knows S1 has their immunizations and was in the process of getting proof from the Dr. Licensee will send proof of immunizations to LPA by email for S1 by 07/14/2023. LPA provided card with email.
	8 9 10 11 12 13 14	measles. This requirement was not met as evidenced by: S1 did not have proof of immunizations in file.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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