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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215906
Report Date: 05/21/2025
Date Signed: 05/21/2025 01:13:26 PM

Document Has Been Signed on 05/21/2025 01:13 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ZEPEDA FCC AKA TINY CHILDREN'S CAREFACILITY NUMBER:
426215906
ADMINISTRATOR/
DIRECTOR:		LUPE ZEPEDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 363-0964
CITY:GUADALUPESTATE: CAZIP CODE:
93434
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
05/21/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Lupe ZepedaTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 5/21/25, at 11:20 AM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced random inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Lupe Zepeda, Licensee of the FCCH, and explained the nature and purpose of the inspection. The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The house is a 3 bedroom and 2 bathroom single story home. The areas that are accessible for day care children are as follows: living room (main day care area), one hallway restroom, and the backyard. The remainder of the home is excluded from childcare services. At the time of the inspection, LPA observed 7 day care children present, 4 of whom are infants. LPA also observed one staff assistant (cleared and associated).

LPA observed the FCCH to be clean and orderly. The bathroom utilized for childcare is clean and free of toxins. The bathroom is nearby the main day care room. In the bathroom, LPA observed grooming and other bathroom products in a locked cabinet. LPA observed sharps in an elevated kitchen cabinet. Personal medication is stored in an elevated kitchen cabinet. Only one child currently requires medication on the Licensee’s roster. Cleaning solutions are stored in the garage and in a locked hallway closet. In addition the closet, LPA observed one more closet in the hallway that solely contains clothing. LPA observed child safety knobs, latches, and other forms of security like gates and screens throughout the residence. LPA observed a First Aid Kit in the day care room for children.

LPA observed age-appropriate toys, furnishings, and equipment throughout the main day care room. The kitchen, which is between the day care room and hallway where the bathroom is located for the FCCH, is made inaccessible by child safety screen. The screen is only opened by staff when children are walked to the bathroom.

LPA observed relevant licensing forms and documents posted prominently within the day care room. LPA (CONT. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ZEPEDA FCC AKA TINY CHILDREN'S CARE
FACILITY NUMBER: 426215906
VISIT DATE: 05/21/2025
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observed smoke and carbon monoxide detectors within the FCCH. Within the kitchen and dining room (which is close by the day care room), a smoke detector and carbon monoxide detector were each tested at 11:37 AM and both were found to be operational. LPA observed a regulation fire extinguisher in the FCCH which was last purchased on 3/5/25. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the FCCH's fire/disaster drill log. The most recent disaster drill occurred on 4/21/25. Licensee informed LPA that disaster drills are conducted on a monthly basis.

As aforementioned, the backyard is accessible to children in care. Along with the License, LPA toured the backyard. LPA observed the area to be fully enclosed by wooden fencing. The fence’s entry and exit gates are secure. The footing of the backyard area is made up of concrete pavement. Like the interior of the FCCH, childcare toys, structures, and play equipment observed in backyard are age appropriate and are in satisfactory condition. Shade is afforded by a large wooden pergola attached with mesh screening and by the residence itself. Licensee was reminded to replace toys and play equipment which start to degrade or are not in good repair. LPA observed no bodies of water throughout the residence. Licensee ensured LPA that children in care are directly supervised when engaged in outdoor activities and that the area is inspected prior to letting children outside.

LPA reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records, among other relevant licensing documents and forms. The Licensee's records were also reviewed. LPA found that the Licensee completed their First Aid/CPR Training (EMSA approved) on 1/16/25, and their Mandated Reporter Training on 2/10/24. Licensee was reminded to renew certifications and training prior to expirations. The Licensee informed LPA that there are no firearms or ammunition that are stored on site.

The Licensee does currently provide Incidental Medical Services (IMS) or administer medication to children in care. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as (CONT. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ZEPEDA FCC AKA TINY CHILDREN'S CARE
FACILITY NUMBER: 426215906
VISIT DATE: 05/21/2025
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an additional resource. Through interview and record review, LPA confirmed that the Licensee checks and documents napping infants every 15 minutes.

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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

During today's visit, no deficiencies were issued.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility when the LPA completed an RSO profile in FAS on 5/21/25.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were also given and signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee, Lupe Zepeda.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
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