197495160-9-14-2022-30-CC-KSCT-CJ9SYM-20220914141747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495160
Report Date: 09/14/2022
Date Signed: 09/14/2022 02:18:52 PM

Document Has Been Signed on 09/14/2022 02:18 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	ZAMORA FAMILY CHILD CARE		FACILITY NUMBER:	197495160
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	09/14/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Alexandra Zamora- Applicant		TIME COMPLETED:	02:35 PM

NARRATIVE

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Licensing Program Analyst (LPA), Keyona Scott, conducted an announced pre-licensing inspection on 09/14/2022 at 10:50 AM. LPA met with Applicant, Alexandra Zamora at 11:13 AM and was guided on a tour inside and outside of the home.

Present during the inspection was Applicant only. Adults residing in the home are Applicant and spouse. All Adults present, residing, working and/or volunteering in the home have a criminal record clearance or exemption.

LPA discussed with Applicant that Applicant is required to be present in the childcare home 80 percent of the time and that supervision is provided to children in care at all times. LPA advised temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Applicant has applied to provide care for children ages zero (0) months to twelve (12) years old. Upon licensure, Applicant will be granted the capacity to care for up to eight children at a time; four infants only or six children with no more than three infants or eight children with no more than two infants and two school age children age six years old or older and one currently attending Kindergarten. Child Care operation hours are scheduled for Monday through Friday, 6:00 AM to 6:00 PM. Per Applicant, children in care will be provided breakfast, lunch and two snacks (morning and afternoon snack) . LPA advised Applicant, meals and snacks brought from the children’s home shall have container(s) labeled with child’s name and properly stored or refrigerated.

Physical Plant

All areas on the facility sketch were identified and inspected, including but not limited to, off limit areas. This is a one-story home that consists of three bedrooms, two bathrooms, living room, dining room, kitchen, and detached garage. Per Applicant, no childcare will be conducted in the detached garage. PAGE 1

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 197495160
	VISIT DATE: 09/14/2022

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Off limit areas of the home are the bedroom that was converted into an office and the bathroom located through the hallway to the East of the home. The office and bathroom are made inaccessible by closed door during operation hours. The Applicant understands that licensing staff may have access to off-limit areas during inspection visits if necessary.

The drop off and pick up area is located at the front entrance of the home. Per Applicant, health assessment checks will be conducted at the childcare entrance prior to the parents leaving and the child(ren) entering into the home.

Primary childcare area (daycare room) is located in the bedroom adjacent to the kitchen. LPA observed changing table, play yard, books, blocks, children chairs, kids kitchen play set and napping cots stored in the closet in the daycare room. There is also a quarter bathroom located in the daycare room in which children in care will utilize. LPA did not observe any dangerous or hazardous items stored in the quarter bathroom. The living room and dining room area will be utilized for mealtime, napping and additional educational activities.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Home has a working telephone. Hazardous materials and sharp objects stored in the kitchen are inaccessible to children. All poisons are locked. The home utilizes window air condition and heat unit as cooling and heating source. Per Applicant, there are no weapons or firearms in the home; none were observed by LPA. LPA advised Applicant if obtains, firearms and ammunition must be stored and locked separately. Per Applicant, there are no pets in the home at this time; none were observed by LPA.

LPA observed fully charged fire extinguisher in the daycare room that is at least a 2A:10BC. The home is equipped with at least one working dual carbon monoxide and smoke detector. There is a first aid kit in the home.

Outdoor play area is located at the South of the home between the home and the detached garage. The outdoor play area is fully fenced and free of dangerous and hazardous conditions. LPA observed children's play slides, tricycles, kids table and bench set, push car and shaded cover in the outdoor play area. Applicant was advised that children shall be physically and visually supervised at all times. Per Applicant, there are no pools, spas, hot tubs, fishponds, or other similar bodies of water on property; none were observed by LPA. PAGE 2

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 197495160
	VISIT DATE: 09/14/2022

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Per Applicant, transportation service will not be provided.

FACILITY RECORDS

LPA received and reviewed current Pediatric CPR and First Aid certificate for Applicant with expiration date of 06/04/2024. Mandated Reporter training was completed on 05/15/2022. LPA advised Applicant Mandated Reporter training is to be renewed every two years. Applicant completed Preventative Health and Safety training with one hour of Childhood Nutrition and Lead Exposure prevention on 06/05/2022. Family Child Care Home Orientation was completed by Applicant on 04/22/2022 and a copy of the certificate was provided to the Department.

While touring the home LPA observed the required form posted on the Parent Board:

Notification of Parent’s Rights (PUB 394)

Applicant has submitted Emergency Disaster Plan to the Department and has on file in the home for review upon request.

Applicant was provided Earthquake Preparedness Checklist (LIC 9148) to review, complete and place on file in the home for review upon request.

LPA advised Applicant, once licensed and receives Facility License (LIC 203) to post on parent board or in an area of the home where it can be easily seen.

Applicant was informed that it is required by law to post the following in the facility:

● Notification of Parents' Rights Poster (PUB 394) - This poster must be placed in an area of the home where all parents can see it
● Facility License, (LIC 203)-Your Family Child Care Home License must be posted in an area of the home where it can be easily seen.
● Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in care) after each site visit by a licensing representative.
● Any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care. PAGE 3

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 197495160
	VISIT DATE: 09/14/2022

NARRATIVE

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Applicant was informed that it is required by law to post the following in the facility (continued):
● Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

LPA provided Applicant with copy of LIC 311D: Forms/Records To Keep In Your Family Child Care Home

The following was thoroughly discussed with Applicant

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 Applicant 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 Applicant 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.

LPA reviewed with Applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 197495160
	VISIT DATE: 09/14/2022

NARRATIVE

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At this time, the facility is ready for licensure. The facility was in substantial compliance during today's inspection on 09/14/2022. The Department agrees to the licensure of a small family childcare for up to eight children at a time; four infants only or six children with no more than three infants or eight children with no more than two infants and two school age children age six years old or older and one currently attending Kindergarten.

Exit interview conducted and report was reviewed with the Applicant, Alexandra Zamora.

PAGE 5

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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