274415414-6-21-2023-07-CC-FCJO-CSZUUS-20230621155401

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415414
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:54:08 PM

Document Has Been Signed on 06/21/2023 03:54 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ZAMORA, MARIA		FACILITY NUMBER:	274415414
ADMINISTRATOR:	MARIA ZAMORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 465-4916
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 7	DATE:	06/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Maria Zamora		TIME COMPLETED:	04:10 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) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Maria Zamora, Licensee, and explained the nature of today's inspection to her. LPA observed there were seven children present today, including one infant, and six preschoolers. Days and hours of operation are Monday to Saturday from 6:00 AM to 6:00 PM The adults that reside in the home are the Licensee and her son Alejandro, and three tenants residing in a studio: Victorina, Hermelinda and Efrain. Licensee's helper Esther Castillo was also present. Also licensee's minor children ages 9 years old reside in the home. Licensee's certifications for CPR and First Aid are current and will expire on 11/21/24 and for her helper on 1/24/25. LPA toured the indoor and outdoor areas of the home during today's visit. The Licensee has a working telephone in the home. LPA reviewed five children's files and they are complete including the parent's rights form and the immunization records form. Licensee has documented a fire drill on 6/06/23. LPA obtained a copy of the children's roster and it is complete and current. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and ready for the day care children. LPA observed a fenced wall heaters inside the home. LPA observed the day care area is located in the living room/kitchen and in the play room. Off limit areas in the home are the four bedrooms, the Family room, and a separate studio unit attached to the home. There are no stairs in the home. LPA observed that besides the play room which has half way walls without windows, there are not other outside areas allowed for child care. Off limit areas outside the home are all off limits. LPA observed a fully charged 3A40BC fire extinguisher last serviced on 4/13/23 working smoke and carbon monoxide detectors, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. Licensee has proof of immunization for herself and for her helper for pertussis, measles, and influenza in file as required by the SB792. ************************Report dated 6/21/23 continues in page 2.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ZAMORA, MARIA	FACILITY NUMBER: 274415414
	VISIT DATE: 06/21/2023

NARRATIVE

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Report dated 6/21/23 continues from page 1.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in care in the home, a helper must be present when there are more than 8 children in care, and ratio (age of the children) must be observed. Licensee understands in absence of a helper her license capacity is automatically reduced to 8 children and ratio must be observed as well. Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.
LPA observed Licensee and her helper have renewed the "mandated reporter" training on 11/18/21 and 1/24/23 respectively. Training is mandatory to all Licensees and adults in the home in contact will children. Licensee understands the training shall be renewed every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

A review of staff records on 6/20/23 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Maria Zamora 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.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

Report dated 6/21/23 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ZAMORA, MARIA	FACILITY NUMBER: 274415414
	VISIT DATE: 06/21/2023

NARRATIVE

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Report dated 6/21/23 continuers from page 2.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email 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/process.

Exit interview conducted and report was reviewed in Spanish with the licensee Maria Zamora.

No deficiencies were cited today.

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

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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