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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413431
Report Date: 08/06/2019
Date Signed: 08/06/2019 04:00:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ZAMUDIO, MICHAELFACILITY NUMBER:
434413431
ADMINISTRATOR:ZAMUDIO, MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 227-0640
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 9DATE:
08/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Zamudio, Michael & JenniferTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA met with Licensee, Zamudio, Michael and spouse/assistant Zamudio,Jennifer and explained the nature of today's inspection. Present during the inspection was the licensee and assistant. There were nine children present, one infant, three toddlers, one kindergarten and four school age. The hours of operation of the day-care are 6:30 AM to 5:30 PM. There are three adults residing in the home; Licensee, spouse and daughter Zamudio, Vanessa. Licensee and assistant have CPR and First Aid, which has an expiration date of 06/2020. LPA reviewed nine children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA observed that the Licensee has record of MMR & Tdap vaccinations as well as the flu vaccine.

LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher and no bodies of water were observed. LPA did not observe any heaters in the home. LPA observed a screened fireplace. Medication, cleaning products and similar items in the home are stored inaccessible to children. Poisons shall be locked. LPA observed a current roster, a current fire disaster/earthquake drills last log 08/2019. Licensee states that there are no weapons in the home. Licensee has two pets, vaccinated. Licensee has no day care insurance. Licensee and assistant have completed Mandated Reporter Training on 07/2018, licensee understands training is to be completed every two years.

Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ZAMUDIO, MICHAEL
FACILITY NUMBER: 434413431
VISIT DATE: 08/06/2019
NARRATIVE
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A review of staff records on 08/05/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

There is one Type B Deficiency during today's inspection.

LPA conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

The following Type B deficiency noted on the attached page (809-D): Appeal rights provided to the Licensee prior to the conclusion of today's inspection.



NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

Report Continued From Page 2*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ZAMUDIO, MICHAEL
FACILITY NUMBER: 434413431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home :The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: This requirement was not met as evidenced by LPA observed licensee failed to meet this requirement. The backyard had items such as tools, machinery and other accessible items
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Licensee will submit a statement via email on or before 08/09/2019 that the backyard will not be used for the children in care until the backyard is approved as safety compliant by licensing. Licensee will remove all items that pose a potential risk to the chidlren in care and/or make them inaccessible with a fence at least five feet high and latch. Licensee will sumbit
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that could pose a risk to the chidlren in care. This poses a potential risk to the health and safety of the children in care.
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evidence via photo on or before 09/06/2019 via fax, email or mail. Once LPA has recieved photos LPA may do a POC visit if neccessary. Licensee has stated a park nearby, across the street will be used for the chidlren in care until backyard has been approved as safety compliant by LPA and/or licensing.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ZAMUDIO, MICHAEL
FACILITY NUMBER: 434413431
VISIT DATE: 08/06/2019
NARRATIVE
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LPA inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; master bedroom/bathroom, one bedroom and garage. Off limit areas outside the home are as follows: Patio, right side and left side of the yard. The front yard is safety compliant and backyard is fully fenced. LPA observed backyard is currently not safety compliant, LPA observed tools, machinery equipment and other items that could pose a potential risk to the health and safety to the children in care. Licensee and LPA discussed a plan to remove such items from back yard. Licensee states a fenced will be built to section off the area where the machinery is and other items will be discarded and/or removed from the property. Licensee and assistant understand the potential risk to the children in care regarding these items. Licensee and assistant will take children to the park across the street until the backyard is safety compliant and licensing has approved the plan of correction. Licensee will submit an updated sketch to LPA. Licensee submitted a new Emergency Disaster Plan during visit, LPA obtained a copy.

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands the capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is transporting of children currently.

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

Report Continued on Page 3*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4