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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211148
Report Date: 01/17/2020
Date Signed: 01/17/2020 11:28:22 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:ZAVALA'S FAMILY CHILD CAREFACILITY NUMBER:
566211148
ADMINISTRATOR:ROCIO ZAVALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 890-7814
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:14CENSUS: 10DATE:
01/17/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rocio ZavalaTIME COMPLETED:
11:30 AM
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On January 17, 2020 at 10:00 A.M. Licensing Program Analyst (LPA) Betzayra Cervantes and Licensing Program Manager (LPM) Mingle made an unannounced visit to conduct an Annual/Random inspection. LPA and LPM met with licensee Rocio Zavala and discussed the nature and purpose of the visit. Together both licensee, LPA and LPM conducted a tour of the home inside and outside. Licensee and her 3 assistants were caring for 10 children in the playroom when LPA and LPM arrived. Licensee was away on an errand and joined the inspection at 10:45 A.M. Assistant present has a valid CPR/First Aid certificate with an expiration date of 03/02/2021.

The licensee uses the playroom, one restroom, and back yard for the day care. Licensee states that there are no firearms and ammunition in the home. LPA observed a safety gate at the base of the stairs leading to the second floor which is off limits to children in care. LPA and LPM did not observe toxins/hazards accessible to children. There are age appropriate toys and furniture readily accessible to children. In the family room, LPA observed a fireplace with a glass screen preventing children from having access. Licensee advised that the main living room is off limits to the children in care and it is secured with a locked door. The back yard is fully enclosed with a fenced wall. Licensee has age appropriate toys and play structures in the back yard in good condition and free of hazards.

The home has working smoke and carbon monoxide detectors. A 2A10BC fire extinguisher was observed mounted in the kitchen wall with a service date of 11/03/2019. Licensee has all required forms posted for parent's to view. A sampling of children records were reviewed and found current and complete. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 12/18/2021. LPA discussed and provided licensee with a Safe Sleep and Effects of Lead Exposure brochures.

Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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: ZAVALA'S FAMILY CHILD CARE
FACILITY NUMBER: 566211148
VISIT DATE: 01/17/2020
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Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
LIC809 (FAS) - (06/04)
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