566215222-8-19-2019-17-CC-LVIA-BF7P6N-20190819110238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215222
Report Date: 08/19/2019
Date Signed: 08/19/2019 11:02:59 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:	ZAMBRANA FCC AKA GIGI'S NURTURING PLACE		FACILITY NUMBER:	566215222
ADMINISTRATOR:	REGINA A. ZAMBRANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 509-6113
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	14	CENSUS: 5	DATE:	08/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Regina A. Zambrana		TIME COMPLETED:	11:10 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Laura Villanueva and Betzayra Cervantes made an unannounced visit to the home to conduct an Annual/random review and met with the licensee, Regina A. Zambrana. The purpose of the visit was discussed and a tour of the one story home was conducted. There was a fireplace at the living room which was observed screened with a metal mesh. Backyard was fully fenced free of hazards. The home uses the living room, dinning area, one bedroom, and backyard for the day-care. Licensee stated that the garage, master bedroom, teenager room, and one bathroom were off-limit to day-care children. LPA found these areas inaccessible during the visit. Age appropriate toys were available for the children inside and outside. Licensee has met compliance for provider immunization(SB792). Children files were complete with required forms. CPR/First aid for licensee was current with an expiration date of 4/8/20. Licensee conducts and maintains a log of fire and emergency disaster drills. Last drill was conducted on 6/26/19. The home maintains a working smoke and carbon monoxide monitor that meets the statutory requirements. Fire extinguisher was purchased 6/16/19. Licensee was reminded the fire extinguisher needs to be serviced or replaced yearly. Licensee has completed the Mandated Reporter AB 1207 on 5/2/18. Child care facility roster was reviewed and found up to date. Licensee has a firearm which was locked in a safe and ammunition locked separate from the weapon. Licensee stated that there were no children on Incident Medical Services at the present time.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

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: ZAMBRANA FCC AKA GIGI'S NURTURING PLACE	FACILITY NUMBER: 566215222
	VISIT DATE: 08/19/2019

NARRATIVE

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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

LPAs provided information on Safe Sleep, Poisonous Plants Poster, Lead Poisoning flyer, and Quarterly Updates are sent to her automatically.

Applicant was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

In the areas that were evaluated, no deficiencies cited under Title 22 Division 12.

Licensee will post the “Notice of Site Visit.”

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

LIC809 (FAS) - (06/04)

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