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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700263
Report Date: 08/22/2022
Date Signed: 08/22/2022 02:02:04 PM

Document Has Been Signed on 08/22/2022 02:02 PM - 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:PEREDA LOPEZ, ZAHAIRAFACILITY NUMBER:
015700263
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
08/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Zahaira Pereda-LopezTIME COMPLETED:
02:10 PM
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On August 22, 2022 at approximately 11:15am Licensing Program Analyst (LPA) Russ Haderer arrived unannounced for an annual inspection for health and safety. Present for the inspection was the licensee and TB and fingerprint cleared daughter and a visiting niece and 3 children in care (1 two-years-old; 1 three-years-old; 1 four-years-old). The hours of operation remain Monday-Friday, 7:00 AM to 6:00PM.

The facility is a single story 3-bedroom, 2 bath home with an attached 2-car garage (including an inground swimming pool in the back yard with a 5-foot fence surrounding the pool – see below). The back yard has a gazebo and a small pumphouse for the pool. There is a living room with a covered fire place, family room with a faux fireplace feature built into the wall, dining room, large kitchen (half has the stove and sink area, the other half was formerly the kitchen and has been covered into a bar area), three bedrooms (1 master with an attached sunroom), attached 2-car garage an enclosed (fenced) side and backyard area.

POOL: The backyard has an in-ground pool with a five foot fence completely surrounding the perimeter. The pool fence is constructed with a mesh material to allow for visual view into the pool. There is a gate that swings away from the pool and has a self-closing and self-latching gate with the latch at the top.

On-limit-areas include: Entryway of the home, family room, bar area of the kitchen, the NW side bedroom for napping and main house bathroom on left side of the bedroom for napping, and main back yard area, the gazebo and the outside perimeter of the pool fence surrounding the pool in the backyard. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: The living room, dining room; hallway leading to the SW and NW bedrooms, the bedroom on the SW side and the master bedroom and bathroom on the NW side; the sun room, the attached 2-car garage, front yard and fenced side yards and inground pool in the backyard and pool pumphouse. The off-limit areas will be inaccessible by closed and/or locked doors, child gates and/or by child supervision.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263
VISIT DATE: 08/22/2022
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The home is owned by the licensee. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the on-limits bedroom away from the other children in care.

There is a faux fireplace on the wall of the family room (day care area) with a glass door to prevent child access. This feature will not be used when children are present. Children have cubbies for personal item storage. A copy of the deed is available showing the licensee owns the property. Per licensee, there are no firearms in the home.



Licensee has ample age-appropriate toys and learning materials inside and outside. In the backyard there is a large children’s play structure in the backyard for climbing with a slide and swings and is securely attached to the ground. There is a gazebo for seating with covered gas and charcoal barbeques, and a covered pizza oven and a non-functioning fire pit. If the fire pit is repaired, it will not be used while children are in care. There is a covered sandbox containing clean sand and toys and other age-appropriate toys for children to play with.

The home has a fully charged 2A10BC fire extinguisher, working smoke detectors throughout and a carbon monoxide detector (tested and functioning), and a working telephone. The licensee’s Health and Safety training was completed 6/13/2021 (including the nutrition and Lead Poisoning Prevention requirements), CPR and First Aid certificate is current and expires 6/5/2023. Mandated Reporter has been completed and expires 7/28/2023. The licensee is in compliance with all immunization laws which pertains to day care providers.

LPA reminded licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Children’s files were reviewed. All files were complete and in good order.

LPA did not observe any bodies of water (other than the appropriately fenced and enclosed in-ground pool), hazardous materials, or toxins accessible to children on the premises during the inspection.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
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: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263
VISIT DATE: 08/22/2022
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no deficiencies issued today. This report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Zahaira Lopez.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
LIC809 (FAS) - (06/04)
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