<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403445
Report Date: 08/25/2021
Date Signed: 08/25/2021 04:32:46 PM

Document Has Been Signed on 08/25/2021 04:32 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: 14CENSUS: 12DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Karen Zavala TIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/25/21 at 2:00 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection at Karen Zavala Large Family Childcare Home. LPA met with Karen Zavala and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family Childcare Home days and hours are Monday to Friday 6:00 AM to 6:00 PM. Present in the home at time of inspection were 4 infants 7 preschool and 1 school-age child, licensee, licensee's son and assistant.

Indoor Space: At 2:05 PM A health and safety tour of inside the home was done. LPAs toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A40BC fire extinguisher, smoke alarm (hardwired through the burglar alarm system) and carbon monoxide detector in the home. The home is a one story consisting of 4 bedrooms, 2 bathrooms, living room, eat-in kitchen, family room, preschool room located in the backyard with bathroom and garage.

The OFF-LIMIT area is garage, which is inaccessible to children in care by closed locked doors and visual supervision. IN-USE The family room, living room, kitchen, backyard, 4 bedrooms, 3 bathrooms, preschool room and preschool room bathroom is used as the primary areas for day-care. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and draws with latches. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are 4 dogs and no arms and ammunition stored in the home. The fireplace is screened, and the home maintains a working telephone.

Outdoor Space: AT 2:25 PM LPA toured the outdoor area (backyard) and observed it was fenced. Play structure and toys are age appropriate. LPA discussed with licensee that there needs to be supervision when children are outside playing when playing with water. LPA observed there are no pools, hot tubs or other bodies of water.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZAVALA, KAREN
FACILITY NUMBER: 073403445
VISIT DATE: 08/25/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training, pediatric CPR and first aid expires 8/20/23, immunization against influenza, pertussis, measles and influenza vaccination verification. Assistant immunization's were reviewed.

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. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.



At 4:15 PM Exit interview was conducted with licensee Karen, where this report and citation were reviewed and discussed. Report was signed by the licensee confirming receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE HOME FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/25/2021 04:32 PM - It Cannot Be Edited


Created By: Michelle Sutton On 08/25/2021 at 04:19 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: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2021
Section Cited
HSC
1596.8662(4)(b)(1)

1
2
3
4
5
6
7
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter
training provided [...] and shall complete renewal mandated reporter training every
two years[...]. .This requirement is not met as evidenced by:
1
2
3
4
5
6
7
By 9/15/2021 Asistant must submit proof of Mandated Reporting Training per AB1207 Child Care Providers.
8
9
10
11
12
13
14
Per LPAs observation and file review, licensee and assistant have no proof of current mandated reporter training. This is a potential risk to health and safety of children in care
8
9
10
11
12
13
14
Assistant shall complete General and Childcare Providers sections.
mandatedreporterca.com

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Michelle Sutton
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
Page: 3 of 3