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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415718
Report Date: 08/14/2024
Date Signed: 08/14/2024 12:48:03 PM

Document Has Been Signed on 08/14/2024 12:48 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ZAVALA FAMILY CHILD CAREFACILITY NUMBER:
197415718
ADMINISTRATOR/
DIRECTOR:		ZAVALA, LYDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 299-8888
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Lydia ZavalaTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 8/14/2024 at 9:45 AM Licensing Program Analysts (LPA) Claudia Kam conducted an Unannounced Required 1 year Annual inspection to the above facility. LPA disclosed the purpose of the inspection and met with Licensee, Lydia Zavala who guided the LPA on a tour of the facility.

There are 5 adults living in the home. All adults in the home were found to have criminal record clearance. Licensee states that there are currently 8 children enrolled. The children's roster was reviewed and is current. During the inspection, no children were present as all children enrolled are school age. No staff were present at time of inspection only licensee. Licensee reports that the facility’s hours of operation are 6:00 AM to 6:00 PM, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Per Licensee, disaster drill was last conducted on 8/12/2024.

This is a single-story home which consists of three bedrooms and one bathroom, kitchen, living room, and front yard. The home is off limits to children and parents. The day care takes place in an adjoining room attached to the home with its own separate entrance and no accessible doors from the home to the day care area. The day care area is fully accessible to the children with no off limits areas. The space has a kitchen, bathroom, laundry nook and open floor plan care area. Areas that will be used for isolation of sick children will be the corner quiet space. LPA observed that there is are child locks on a high cabinets for all cleaning supplies making it inaccessible to children in care at time of inspection.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. Main Care Area for day care children was toured and the kitchen was found in compliance for safety, cleanliness, and proper storage. Care area is equipped with a play kitchen, cubbies with toys for school age such as toy figures, Legos, and crafting supplies. Addition cubbies have preschool toys mazes, writing boards, books and infant toys. There are toddler size table and chairs as well as adult size chairs and tables for the school age children for meals and activities. Large wall mounted television observed. Changing table, and high chair observed as available.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA FAMILY CHILD CARE
FACILITY NUMBER: 197415718
VISIT DATE: 08/14/2024
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Cribs and cots were observed however there are no infants in care at this time. LPA observed an A/C mobile unit in the space to maintain a comfortable temperature. There is a working telephone maintained in the home via cell phone which licensee was reminded must stay in the home during care hours.

Per licensee, the children will have access to the front yard for outside play. LPA observed yard to be fully cemented as it is used for ride on toys such as bicycles, tricycles and ride on toys and sports, it was observed to have adequate perimeter fencing through-out the property. LPA observed the play area to free of loose and sharp parts available for the children in the yard and to be maintained.



The valve on the required 2A 10BC fire extinguisher indicates fully charged, proof of purchase date reflects date of 7/1/2024. LPA tested Smoke and carbon monoxide detectors and are in operable condition at time of inspection. Hazardous items including poisonous cleaning compounds per licensee are not kept in the home or care area. LPA observed First Aid kit kept on shelf in Main Care Area and was inventoried for necessary supplies. Licensee provided proof of immunization against influenza, pertussis, and measles during today’s inspection. Licensee does not have current mandated reporter training or CPR.

—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA did not observe any bodies of water around the premises at time of inspection. Per licensee, they provide food for children in care. Licensee provides breakfast, snack, lunch and dinner.

LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the licensee.

The following were discussed:


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.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA FAMILY CHILD CARE
FACILITY NUMBER: 197415718
VISIT DATE: 08/14/2024
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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.

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.

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.


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/.

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, the Licensee Lydia Zavala, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA FAMILY CHILD CARE
FACILITY NUMBER: 197415718
VISIT DATE: 08/14/2024
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Based on this information the following deficiencies on the LIC 809 D are being cited today 8/14/2024.





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

Exit interview conducted and report was reviewed with the licensee Lydia Zavala.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2024 12:48 PM - It Cannot Be Edited


Created By: Claudia Kam On 08/14/2024 at 12:21 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ZAVALA FAMILY CHILD CARE
FACILITY NUMBER: 197415718

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) 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 pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onrecord review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. Staff do not have current mandated reporter and licensee did not have mandated reporter available at time of inspection
POC Due Date: 09/16/2024
Plan of Correction
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Licensee and staff will take the mandated reporter training and submit verification by due date.
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

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 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2024
Plan of Correction
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Licensee was provided all employee forms and licensee will have staff complete and submit verification by the due date.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Claudia Kam
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/14/2024 12:48 PM - It Cannot Be Edited


Created By: Claudia Kam On 08/14/2024 at 12:21 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ZAVALA FAMILY CHILD CARE
FACILITY NUMBER: 197415718

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

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 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2024
Plan of Correction
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Staff will take the course for preventative health and licensee will submit verification by the due date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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 which poses/posed a potential health, safety or personal rights risk to persons in care. Staff 1 missing measles vaccination, Staff 2 missing all vaccinations.
POC Due Date: 09/16/2024
Plan of Correction
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Licensee will have staff submit verification of vaccination and submit to by the due date.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Claudia Kam
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
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