013423009-2-1-2023-52-CC-SCOZ-CNMN3K-20230201090629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423009
Report Date: 02/01/2023
Date Signed: 02/01/2023 09:06:52 AM

Document Has Been Signed on 02/01/2023 09:06 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZULUETA PINEDA, CLAUDIA		FACILITY NUMBER:	013423009
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	02/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Claudia Zulueta		TIME COMPLETED:	10:21 AM

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Licensing Program Analyst Sidney Cortez, met with licensee CLAUDIA ZULUETA for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee CLAUDIA ZULUETA and 1 pre school age, and 1 kindergarten age child (total of 2 children). The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 6:00AM until 6:00 PM, MONDAY-FRIDAY, and 10AM-5pm on weekends.
The facility is a one story level house. It consists of a living room, 3 bedrooms, one bathroom, kitchen, garage and backyard.
ON LIMIT AREAS are: the living room, the 2 bedrooms located on the right side of the hallway, and the hallway bathroom.
OFF LIMIT AREAS are: the kitchen, the master bedroom and the garage.
The ISOLATION AREA will be the bedroom located on the right side of the hallway.There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children. Per licensee, there are no firearms in the home. The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.

The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (May 2023). The licensee's mandated reporter is current and will expire in April 2023. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on Dec 2022.

2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. Please see 809C for Continuation

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZULUETA PINEDA, CLAUDIA	FACILITY NUMBER: 013423009
	VISIT DATE: 02/01/2023

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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.
The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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