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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403445
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:37:21 PM

Document Has Been Signed on 12/12/2024 02:37 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ZAVALA, KARENFACILITY NUMBER:
073403445
ADMINISTRATOR/
DIRECTOR:		ZAVALA, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
9252521485
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 14TOTAL ENROLLED CHILDREN: 25CENSUS: 10DATE:
12/12/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:42 AM
MET WITH:Karen ZavalaTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
NARRATIVE
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On 12/12/2024 at 10:42AM Licensing Program Analyst (LPA), Kareeca "Reeca" Sykes arrived at the home to conduct an Unannounced Random Annual Inspection. Upon arrival LPA met with Isolda Khamseh who Licensee Karen Zavala stated is her neighbor who helps assist. Shortly after the Licensee Karen Zavala arrived to the home LPA was granted entry into the home to tour the facility. Present during inspection were the licensee, the licensee's adult son and daughter who are fingerprint cleared and licensee’s "assistant (neighbor)" Isolda Khamseh who was not fingerprint cleared. Residing in the home is the Licensee, the Licensee adult daughter, adult son, and licensee's grandson who is a minor. During the inspection LPA observed ten (10) children in care, consisting of 2 infants and 8 preschoolers. Licensee states there are currently 25 children enrolled. Licensee’s home was toured for a health and safety inspection. The facility operates 6:00AM – 6:00PM, Monday - Friday.

This home is single-story home that consists of four (4) bedrooms, two (2) bathrooms, kitchen, dining area, living room, family room (play room), fenced backyard, ADU in the backyard, and garage.


ON LIMIT: Dining room, Living room, Family room (Play room), Two bedrooms (In the hallway to the right), Bathroom (In the hallway), Backyard, and the ADU (Classroom located in the backyard)

OFF LIMIT: The two bedrooms in the hallway to the left, bathroom located in the master bedroom, and the garage.

All off-limit areas have been made inaccessible by closed and/or locked doors and visual supervision.
The ISOLATION AREA is at the table in the dining area away from other children in care.

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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/12/2024 02:37 PM - It Cannot Be Edited


Created By: Kareeca Sykes On 12/12/2024 at 01:15 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZAVALA, KAREN
FACILITY NUMBER: 073403445

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/ interview, the licensee did not comply with the section cited above in ensuring all employees, assistants, and/or volunteers obtain a fingerprint clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Licensee stated they will have all employees, assistants, and volunteers fingerprinted and will submit a photo of the reciept to LPA by 12/16/24/ COB
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2024


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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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZAVALA, KAREN
FACILITY NUMBER: 073403445
VISIT DATE: 12/12/2024
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Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There is a fireplace in the family room (play room) which Licensee states is not used and has been made inaccessible to children in care. There are ample amount of safe toys, play equipment, and materials observed for children. There is a working telephone in the home. All poisons, cleaning solutions, medications, and other items that pose a danger to children are inaccessible during this visit. The licensee does understand that poison must be in a locked cabinet/drawer or placed out of reach of children. Knives were kept in a locked storage cabinet. The home is equipped with a fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detector. Licensee states are two (2) pets (small dogs) in the home and there are no firearms on the premises. There are no pools, spas, hot tubs, fishponds or similar bodies of water. Licensee has current CPR and First Aid training which expires on 10/11/2026.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers Licensee completed training on .

LPA observed and inspected sleeping equipment for infants. All equipment meets the US Consumer Product Safety Commission standards. LPA observed that cribs and/or play yards were free from loose articles and objects. There are no objects hanging above or attached to the side of the crib. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months of age should be placed on their back for sleeping.



This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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


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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZAVALA, KAREN
FACILITY NUMBER: 073403445
VISIT DATE: 12/12/2024
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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.

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 [facility representative] 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 following was discussed:

· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.


· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809D. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

Exit interview was conducted with Licensee.

The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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