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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215835
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:20:26 PM

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:ZAMORA FAMILY CHILD CAREFACILITY NUMBER:
566215835
ADMINISTRATOR:ISA EMMA ZAMORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 415-1708
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 12DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Isa Emma ZamoraTIME COMPLETED:
12:30 PM
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On July 28, 2021 at 11:00 AM Licensing Program Analyst (LPA) Laura Villanueva conducted an unannounced inspection to complete a Required - 1 Year visit. LPA met with Licensee, Isa Emma Zamora. Due to COVID-19 pandemic, LPA asked the pre screening questions, Licensee's responses indicate no COVID-19 exposure on site. Licensee takes children's temperatures and record them daily upon arrival. LPA toured home inside and outside with Licensee. The facility is a 4 bedroom 3 bathroom 2 story home. The stairs are barricaded with a gate to keep children safe. The Licensee uses the first floor for the child care. The fireplace is screened off with a metal cover making it inaccessible to the children in care.

There are age appropriate toys and equipment. LPA did not observe any toxins/hazardous items accessible to children, they are locked in a hall closet. LPA did not observe any bodies of water. There are no guns or weapons in the home. The regulation 2A10BC fire extinguisher was serviced on 4/5/21. Applicant is reminded to service or purchase the fire extinguisher yearly. The combination smoke/carbon monoxide detector was observed on the ceiling in the hallway. Licensee's Pediatric First Aid/CPR certificate is valid until 3/16/23. Mandated Reporter training was completed on 3/29/21 for Licensee. A documented fire drill was conducted on 7/13/21.

LPA reviewed child files and found them to be complete and organized. An LIC9227 Individual Infant Sleep Plan was completed for C1 along with documented sleep checks.

LPA reviewed SB 792 the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA advised the Flu Vaccine may be completed yearly between August 1 - December 1, or complete a waiver.

Continued on LIC809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
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: ZAMORA FAMILY CHILD CARE
FACILITY NUMBER: 566215835
VISIT DATE: 07/28/2021
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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

LPA found child care home well organized and in complete compliance with Title 22 regulations. No deficiencies are cited today.

An exit interview was conducted with Licensee. A safe sleep pamphlet was left for Licensee to review. A copy of this report was given whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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