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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021426
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:28:32 PM

Document Has Been Signed on 04/18/2024 02:28 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ZAVALA NUNEZ FAMILY CHILD CAREFACILITY NUMBER:
198021426
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Applicant Karen ZavalaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 4/18/24 at 12:40pm, Licensing Program Analyst (LPA) Stephanie Li conducted an announced Pre-Licensing inspection on this date for the purpose of inspecting the facility to ensure the health and safety standards as required by the regulations governing childcare homes are met for initial licensure. A copy of the Pre-licensing Entrance Checklist for Child Care homes form (LIC 9280) was provided.

LPA met with applicant Karen Zavala who confirmed the family members residing in the home, that consists of 2 adults and 2 minor children. Present during this inspection was Applicant and 2 children. Applicant is requesting a small (8 Capacity) family child-care home license. Per Applicant, operating hours will be Monday to Friday, 7:00AM to 5:00PM. Applicant states that she will care for children 0 months - 13 years of age.

At 1:10pm, Karen guided the LPA on a tour of the facility, indoors and out. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. Licensing staff advised that if children bring food from home, it should be properly labeled. The home was inspected for safety, comfort, cleanness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Per applicant there are no weapons or firearms currently in the facility. The backyard is adequately fenced and there is NO swimming pool, or spas. LPA observed a partial fence separating the parking space and the right side of the yard. LPA observed construction materials on the other side of the yard. Per applicant, her husband works in construction and sometimes uses the yard for his tools. Per applicant, she is waiting for a delivery from fed ex to attach the last gate onto the exterior of the wall, limiting access to other side of yard. Per applicant, she will have the gate attached by Monday 4/22/24.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021426
VISIT DATE: 04/18/2024
NARRATIVE
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LPA observed the smoke detector and carbon monoxide were tested and verified to be in operable condition. LPA also observed the required fire extinguisher (2A 10BC) located in the play room wall was last serviced on 7/18/23 per service tag.

The areas observed by the LPA and confirmed by the applicant during the inspection, were the:

Off limits areas are: 3 bedrooms, 1 bathroom, driveway & back side yard. Reminded applicant, rooms that are off-limits need to be made inaccessible during operating hours. The applicant does understand that licensing staff may have access to off-limit areas during the inspection if necessary.

Areas used by children are: Living room, kitchen and dining room, hallway bathroom, play room (garage) & fenced back yard. Areas that will be used by children were inspected for safety, comfort, and cleanliness. The garage room will be the main day care area. Karen stated that children will nap in the living room and eat in the dining room. LPA observed there are age-appropriate toys and napping equipment.

Because the applicant owns the home, proof of landlord notification is not required.

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-andresources/safesleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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.

The applicant has completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR exp 5/14/24 . Applicant completed mandated reporter training. exp.3/22/26. LPA observed there are first aid supplies available on the premises.

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) or (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.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021426
VISIT DATE: 04/18/2024
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At 1:30pm the following was discussed with the applicant:

• Criminal Record Clearance-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, 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.

• In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.

• Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.

• The fire extinguisher type 2A-10BC must be serviced or purchased annually per State Fire Marshall standards. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

• Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

• Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

• Fire and safety drills must be performed every 6 month and documented for review by the Department.

• Smoking is prohibited in a family childcare homes.

• Children and Staff records must be maintained and updated as needed and must be available for review by the Department. If Children and Staff leave the day care all records must be maintained for 3 years after leaving.

• No infant walkers, no Johnny jumpers, no saucer chairs, no trampolines and any other item that falls into those category’s, are not permitted in the facility.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021426
VISIT DATE: 04/18/2024
NARRATIVE
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• Inspection Authority: All adults living and working in the home shall be made aware of the Department’s right to inspection of the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults, review documentation and observe off limit areas if needed.

• The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.

• Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

• Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

• Immunization Requirement: H&S 1597.622: 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 (Tdap), & measles (MMR). The licensee & all adults working with children must have proof of immunizations.

• Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees are to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

• LPA advised the applicant how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

At 1:50 pm 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. Entrance Checklist was provided to the applicant.

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 platforms.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ZAVALA NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021426
VISIT DATE: 04/18/2024
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication. Applicant’s email address was verified/obtained during this inspection. The applicant was advised that the email may be public information. (Zavalafamilydaycare@gmail.com)

MyChildCarePlan.org – Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

On, 2/01/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under penalty of perjury that the statements on the application and any attachments are correct.

Based on licensing staff observations, the following corrections need to be corrected prior to obtaining a family childcare license. Corrections are due before or by: 04/22/2024.

1) Attach last gate to exterior wall to make left side of yard inaccessible.

Once the pending corrections are cleared the application will be submitted for final file review and license approval. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Exit interview conducted and report was reviewed with the applicant Karen Zavala.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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