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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700263
Report Date: 08/24/2023
Date Signed: 08/24/2023 12:47:16 PM

Document Has Been Signed on 08/24/2023 12:47 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PEREDA LOPEZ, ZAHAIRAFACILITY NUMBER:
015700263
ADMINISTRATOR:PEREDA LOPEZ, ZAHAIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 449-2984
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 5DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Zahaira Pereda LopezTIME COMPLETED:
01:10 PM
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On August 24, 2023 at approximately 9:00am Licensing Program Analyst (LPA) Haderer arrived for an unannounced annual inspection for health and safety. Present for the inspection was the licensee Zahaira Lopez Pereda, her fingerprint cleared and TB tested adult daughter, and 5 children in care (2 infants; 1 two-years old; 1 three-years old; 1 four-year old). The facility is in ratio today. Hours of operation are 7:30 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 fireplace, 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. 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.

POOL: The backyard has an inground 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.



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. The home has a fully charged 2A10BC fire extinguisher mounted on the kitchen wall and a second extinguisher under the kitchen sink. There are working smoke detectors throughout the home; a carbon monoxide detector (tested and functioning), and a working telephone. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 3/7/2023. All required licensing documents are posted and visible for public review.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263
VISIT DATE: 08/24/2023
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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 sunroom, the attached 2-car garage, front yard and fenced side yards and inground pool in the backyard and pool pumphouse. The off-limit areas are inaccessible by closed and/or locked doors, child gates and/or by child supervision.

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.

Children's files were reviewed and found to be complete and in good order. The facility roster was reviewed, and a copy obtained. LIC9227 infant sleep plans signed/dated for two infants, however sleep logs have not been maintained for all infants up to age 2 – see LIC809D for deficiency. The licensee owns the property but does not carry liability insurance. LIC282 forms with parent’s acknowledgement of no liability insurance were signed/dated in each child’s file.

Infant safe sleep – A six-month old infant was sleeping in a crib in a Dock-A-Tot pad and a loose blanket and a few other loose items (toys). Cribs must be clear of all loose articles and objects. There should be nothing in the crib, other than the infant on a firm mattress with a fitted sheet that is appropriate for the mattress size – see LIC809D for two deficiencies.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263
VISIT DATE: 08/24/2023
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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.

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 7/05/2025. Mandated Reporter has was completed but expired 7/28/2023. Licensee stated she renewed it, but the computer crashed and the certificate cannot be printed. Licensee to log in with a different computer and retrieve certificate – a technical violation was issued. The licensee is in compliance with all immunization laws which pertains to day care providers.



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

LPA did not observe any bodies of water (other than the appropriately fenced and enclosed inground pool), hazardous materials, or toxins accessible to children on the premises during the inspection.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263
VISIT DATE: 08/24/2023
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, licensee Jahaira Lopez confirmed there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

The following 3 deficiencies were observed during today's inspection:

· Infant sleeping in a crib with loose articles in the crib (a blanket and toys) that can cause suffocation


· Infant sleeping in a crib with a Dock-A-Tot (similar to bumper pads) that can cause suffocation
· Infant sleep logs were not being maintained

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

**Please see LIC 9102 for Advisory Notes.

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: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/24/2023 12:47 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/24/2023 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that crib had a blanket in the crib covering the child, a few toys and was sleeping in a Dock-A-Tot which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/24/2023
Plan of Correction
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Licensee removed the blanket, toys and Dock-A-Tot pad. Going forward, cribs for infants must be clear of all loose articles and objects. There should be nothing in the crib, other than the infant. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
Section Cited
CCR
102425(b)(2)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (2) Bumper pads shall not be used.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that infant crib has a Dock-A-Tot for the infant to sleep in to keep him on his back which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/24/2023
Plan of Correction
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Licensee removed the Dock-A-Tot pad. Going forward, cribs for infants must be clear of all loose articles and objects. There should be nothing in the crib, other than the infan. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/24/2023 12:47 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/24/2023 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREDA LOPEZ, ZAHAIRA
FACILITY NUMBER: 015700263

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that sleep logs were not being used for all infants up to age two which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/24/2023
Plan of Correction
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Napping children must be checked every 15 minutes and document the date; infant’s name; time of each 15-minute check. These sleep logs must be maintained for all infants us to two years in age. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


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