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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403445
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:58:19 PM

Document Has Been Signed on 09/15/2022 02:58 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ZAVALA, KARENFACILITY NUMBER:
073403445
ADMINISTRATOR:ZAVALA, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 252-1485
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 14TOTAL ENROLLED CHILDREN: 25CENSUS: 12DATE:
09/15/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Karen Zavala TIME COMPLETED:
03:00 PM
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On 9/15/22 at 1:55 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced case management for Plan of Corrections. LPA met with the assistant Carolina Flores and discussed the purpose of the inspection. Licensee was not present during inspection due to pick-up and drop-off of children. Licensee has a Large Family Child Care Home with a capacity of 14. Present for the inspection were licensee's 2 assistant, 3 infants and 9 preschool children.

During the inspection operations of a family childcare home were discussed. Letter of Deficiency Citation Cleared was given to licensee for Type A cited on 9/8/22 for Staffing Ratio and Capacity.

There were no deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee's assistant Carolina Flores.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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