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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444409044
Report Date: 07/18/2019
Date Signed: 07/22/2019 07:44:39 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2019 and conducted by Evaluator Elizabeth Berumen
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20190424154724

FACILITY NAME:ZAMORA, MARIAFACILITY NUMBER:
444409044
ADMINISTRATOR:MARIA ZAMORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-5906
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 13DATE:
07/18/2019
ANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maria ZamoraTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) met with Licensee, Maria Zamora for the purpose of delivering findings on above stated allegation.
On April 25, 2019, LPA Berumen observed Licensee at the bus stop picking up school age children. LPA waited until Licensee returned to Family Child Care to conduct the inspection. Upon arrival LPA observed the two children she picked up from bus stop in dining area and 9 napping day care children with Mother in law, Esperanza Zamora.
Licensee left her assistant alone with 9 children (1 infant, 8 preschoolers) while she walked to the bus stop to pick up two school age children. No other adult assistants were present on April 25, 2019.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC. 9099D.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20190424154724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ZAMORA, MARIA
FACILITY NUMBER: 444409044
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2019
Section Cited
CCR
102416.5(e)
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Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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LPA explained the situation and staffing ratio & capacity to the Licensee. Licensee agrees to submit a written plan of correction to the licensing office by 07/19/19. Licensee will ensure that facility is in compliance with Title 22 Regulation Section 102416.5(e).
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This requirement was not met as evidenced by: Licensee left her assistant alone with 9 day care children while she picked up 2 school age children from the bus stop.
This presents an immediate health and safety risk to children in care.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3