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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215932
Report Date: 05/08/2020
Date Signed: 05/08/2020 10:28:44 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 FCC AKA ZEPEDA HAPPY KIDS HOME DAYCAREFACILITY NUMBER:
426215932
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
05/08/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marisela ZepedaTIME COMPLETED:
10:30 AM
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On 04/06/2020, Licensing Program Analyst (LPA) Christian Patterson received an application from Licensee Marisela Zepeda requesting a Change of Capacity. Due to COVID-19, Licensee utilized the Facility Pre-Licensing Self Certification Checklist for Family Childcare Homes as well as the Licensee Bodies of Water Checklist to certify the home as adhering to Title 22 Regulations. A fire clearance inspection of the home was conducted on 04/16/2020. LPA Patterson reviewed all documents and found them to be complete with Licensee adhering to Title 22 Regulations on 05/04/2020. A tele-inspection of the facility was completed on 05/08/2020.

Licensee uses the living room, kitchen, dining room, back yard, and one bathroom for day-care. The bedrooms will be off limits. The 2A10BC regulation fire extinguisher was purchased on 01/26/2020. During the initial Prelicensing inspection to the home on 03/17/2020, LPA observed functioning smoke and carbon monoxide detectors in the home. LPA observed a gate in the dining room, living room and locks on two-bedroom 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 09/18/2019. Applicant First Aid/CPR certificates is valid until 05/2021. Applicant AB 1207 Mandated Reporter Training Certificate expires 03/2022.

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

DATE: 05/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2020
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: ZEPEDA FCC AKA ZEPEDA HAPPY KIDS HOME DAYCARE
FACILITY NUMBER: 426215932
VISIT DATE: 05/08/2020
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Incidental Medical Services (IMS) policy was discussed. 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

Licensee is reminded that they are responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed the handouts "Safe Sleep in Child Care, A Child Care Provider's Guide to Safe Sleep, and the Effects of Lead Exposure".


There were no deficiencies cited today. The LIC 9213 (Notice of Site Visit) was emailed to the Licensee.

The facility is licensed for a capacity of 14 children effective today, 05/08/2020.

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

DATE: 05/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2020
LIC809 (FAS) - (06/04)
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