105620110-1-20-2023-57-CC-NLOI-CN9Q8J-20230120105648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 105620110
Report Date: 01/20/2023
Date Signed: 01/20/2023 10:56:59 AM

Document Has Been Signed on 01/20/2023 10:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	ZAVALA, ROSEMARY FAMILY CHILD CARE		FACILITY NUMBER:	105620110
ADMINISTRATOR:	ZAVALA, ROSEMARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 643-1262
CITY:	ORANGE COVE	STATE: CA	ZIP CODE:	93646
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/20/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rosemary Zavala		TIME COMPLETED:	11:00 AM

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 January 20, 2023, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Rosemary Zavala for a pre-licensing/ change of location inspection. Applicant and boyfriend reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on 01/09/23. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: Fire clearance was received on 01/10/23. Applicant states that fire inspector did not require for her to install a fire pull alarm. This is a single story, four bedrooms and two bathrooms home and children will have access to the living room, dining room/kitchen, bedroom #2 (day care room), bedroom #3 (napping room), and hallway bathroom. Off-limits rooms are made inaccessible by use of lever locks. There is no fireplace in the home. LPA observed children size furniture, safe toys, books and instructional materials for the day care children. Children will nap in bedroom #3 on mats. Infants will nap on play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ZAVALA, ROSEMARY FAMILY CHILD CARE	FACILITY NUMBER: 105620110
	VISIT DATE: 01/20/2023

NARRATIVE

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Fenced backyard will no be accessible to the day care children. Applicant will ensure the glass sliding door is kept locked during day care hours.
SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on 08/01/22. Applicant’s Assistant completed the training on 10/18/22.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 5:00 AM to 5:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Provisional License for a Large Family Day Care Home capacity of 14 children ages under 18 years will be issued for 90 days, pending receipt of the Preventive Health and Safety Training certification. Provisional license will be effective 01/23/23.
(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ZAVALA, ROSEMARY FAMILY CHILD CARE	FACILITY NUMBER: 105620110
	VISIT DATE: 01/20/2023

NARRATIVE

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Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on 01/14/24. Applicant’s Assistant, Jonathan Lomeli completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on 01/14/24.
Preventative Health and Safety was completed on 02/18/20. Applicant will need to update the Preventative Health and Safety with Lead exposure certification.
Knives and medications are stored in the kitchen pantry that is made inaccessible by the use of a lever lock. Cleaning compounds are stored inside the bottom cabinet that is located underneath the kitchen sink and made inaccessible by the use of a child proof safety latch.
Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
There are no bodies of water in the home or premises.
There are four dogs that are inside their individual kennels and located in a fenced area in the backyard. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
Applicant states there are no firearms, ammunition or poisons in the home or premises.
Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
Applicant states she will be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

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