198019086-10-21-2021-54-CC-KCHE-C7ZTMP-20211021145128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019086
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:51:42 PM

Document Has Been Signed on 10/21/2021 02:51 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ZAMORA FAMILY CHILD CARE		FACILITY NUMBER:	198019086
ADMINISTRATOR:	ELVIRA ZAMORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 649-9251
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90002
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 5	DATE:	10/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Elvira Zamora, Licensee		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 10/21/2021 at 12:05 PM. LPA conducted COVID-19 Screening Call prior to entering facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Elvira Zamora, who guided the LPA on a tour of the facility. At 12:10 PM, LPA observed Adult 1(A1), providing care to children, did not have criminal record clearance at time of inspection. A1 states that she has been working at facility for two months, Licensee confirms A1 is her Assistant and provided clearance paperwork submitted. Individuals living in the home were discussed. There were five day care children present in beginning of inspection. and four children by end of inspection. Licensee states that there are currently ten children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 7am to 7pm, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 09/19/2021. This is a single story home which consists of three bedrooms and two bathrooms, kitchen, living room, and converted detached garage. Areas used by the children include the living room (located upon entry of home) which Licensee states is used for for eating and napping, converted detached garage for day care activity space, and Bathroom 1(located down hallway in the home). Per Licensee, areas off limits to children and parents include all bedrooms (Bedrooms 1, 2, and 3), Bathroom 2, and Kitchen. At 12:24 PM, LPA observed that there is an operable baby gate making Kitchen off limits to children in care at time of inspection. Per Licensee, off limit bedrooms are also locked during operating hours, LPA observed doors to be locked and signs posted on doors stating area is off limits. 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. At 12:53 PM, LPA observed ceiling fans through the home. There is a working telephone maintained in the home. Day care activity space is Report continues- Page 1 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 198019086
	VISIT DATE: 10/21/2021

NARRATIVE

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converted garage and side patio area. Licensee stated that this area is used only for day care activity space and not for eating, sleeping, or toileting needs. At 12:12 PM, LPA observed high chair (with infant sitting in it upon arrival and was removed at 12:15 PM), child size tables and chairs, blue mats for sitting, shelves with plastic blocks, puzzles, art supplies, dramatic play toys, and other age appropriate toys, free of loose and sharp parts available for children at time of inspection. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 12:18 PM, LPA observed these items kept above a high cabinet above the washer and dryer making these items inaccessible to children in care at time of inspection. At 12:24 PM, LPA observed areas used by the children inside the home for eating and napping to have child size table and chairs, standard blue cots used for napping stored in hallway and wooden crib for infant sleep to have fitted sheet over mattress. At 12:28 PM, LPA observed Bathroom 1 children will use to have operable child safety locks on under cabinet sink, operable sink and toilet, adequate hand washing supplies, and floor to be free of hazards at time of inspection. At 12:58 PM, LPA observed sharp knives to be kept in a drawer with operable child safety locks in off limits kitchen area at time of inspection. The Licensee states that there are no poisons in the home.

Per Licensee, the children will have access to backyard area for outdoor play. At 12:20 PM, LPA observed outdoor play area to be directly next to detached garage, which remains open making outdoor play area accessible to children in care at all times. LPA observed backyard has turf grass, concrete and adequate perimeter fencing through-out the yard. At 12:22 PM, LPA observed sensory bins being used for water play at time of inspection to have less than one inch of water. LPA observed tricycles, plastic ride along toys, plastic play kitchen, wooden climbing structure with plastic slide, busy boards hanging on walls, and other age appropriate toys free of loose and sharp parts available for the children in the backyard, and all trees, shrubs, and plants are maintained at time of inspection.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms at time of inspection. Per Licensee, they provide food for children in care, LPA observed children eating lunch at time of inspection.

At 12:54 PM, LPA observed a small dog in the home. Licensee states dog is kept separate from children at all times. LPA observed dog to be kept in the room when children are in the home for eating and napping.
Report continues- Page 2 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 198019086
	VISIT DATE: 10/21/2021

NARRATIVE

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At 12:22 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with purchase receipt observed 08/15/2019. At 12:30 PM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. At 12:22 PM, LPA observed First Aid kit hanging by side door entrance and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 06/03/2023
—Mandated Reporter AB1207 Completed: 06/13/2021
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following were discussed:
Incidental Medical Services (IMS)
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee states that she will keep sick children in living room as isolation area and wait there with child until child gets picked up.

Liensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

Report Continues - Page 3 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 198019086
	VISIT DATE: 10/21/2021

NARRATIVE

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The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of LIC995 Parent's Rights and LIC 282 was provided.

The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Elvira Zamora.

Report Ends - Page 4 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/21/2021 02:51 PM - It Cannot Be Edited

Created By: Katrina Chicote On 10/21/2021 at 02:09 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: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 198019086
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 12:20 PM, LPA observed Adult 1(A1) providing care for children in care. A1 is not associated to facility. Upon further review, Licensee provided documents showing fingerprint cleerance request. LPA reviewed paperwork and logged onto Guardian which stated further documents needed. LPA provided letter to Licensee and A1 at time of inspection. This poses a potential health, safety, and personal rights risk to children in care at time of inspection.
	POC Due Date: 10/25/2021
	Plan of Correction
1 2 3 4	Licensee states she will email photo proof of submission of required forms by POC date.

Type B

Section Cited

CCR

102419(d)

Admission Procedures and Parental and Authorized Representative's Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:30 PM, LPA conducted record review and did not observe LIC995 in any 5 out of 5 children's files at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
	POC Due Date: 10/25/2021
	Plan of Correction
1 2 3 4	Licensee states she will email photo proof of signature of forms by POC 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:

Trevino Cochran

LICENSING EVALUATOR NAME:

Katrina Chicote

LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

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