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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215906
Report Date: 01/07/2020
Date Signed: 01/07/2020 10:06:18 AM

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:ZEPEDA FAMILY CHILD CARE AKA LUPE ZEPEDAFACILITY NUMBER:
426215906
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
01/07/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lupe ZepedaTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Christian Patterson made an announced inspection to conduct a PRE-LICENSING inspection on 01/07/2020. LPA met with Applicant Lupe Zepeda. Together the LPA and applicant toured the home inside and outside. The applicant will be using a play room, kitchen, dining room, back yard, and one bathroom for day-care. The living room, bedrooms, and garage will be off limits.

LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher purchased on January 02, 2020 was observed. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed functioning smoke and carbon monoxide detectors in the home. LPA observed a gate in the dining room and locks on bedroom and garage doors keeping areas inaccessible to children. There are age appropriate toys and day-care equipment in the home. The fenced back yard has age appropriate toys and day-care equipment. LPA advised applicant must provide visual supervision while the children are playing both inside the home and outside in the backyard. Licensee stated that there are no firearms or ammunition in the facility. Preventative Health & Safety and Nutrition Training was completed on 03/04/19. Applicant First Aid/CPR certificates is valid until 03/21. Applicant AB 1207 Mandated Reporter Training Certificate expires 12/21.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ZEPEDA FAMILY CHILD CARE AKA LUPE ZEPEDA
FACILITY NUMBER: 426215906
VISIT DATE: 01/07/2020
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Applicant provided mortgage statement to verify control of property. LPA discussed and verified SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers and any similar object that restricts children's movement are prohibited from licensed facilities.

LPA reviewed, discussed, and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the Family Child Care Home (FCCH). LPA discussed information about Sudden Infant Death Syndrome and Capacity requirements. A guide to Effects of lead poisoning and Safe Sleep pamphlet were provided to applicant. Applicant was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov. Currently the applicant does not have liability insurance and will be looking into obtaining it. LPA informed applicant that she will need parents to sign a waiver for the liability insurance should she not obtain the liability insurance. 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

License to operate a Family Child Care facility is effective today (01/07/2020)

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
LIC809 (FAS) - (06/04)
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