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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336301086
Report Date: 07/22/2025
Date Signed: 07/22/2025 01:09:25 PM

Document Has Been Signed on 07/22/2025 01:09 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ZARAGOZA FAMILY CHILD CAREFACILITY NUMBER:
336301086
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
07/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:36 AM
MET WITH:Ma Del Carmen ZaragozaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 07/22/2025 at 11:36 AM, Licensing Program Analyst (LPA) Gabriela Hernandez conducted an unannounced annual inspection for a small family childcare. LPA met with Licensee Ma Del Carmen Larios De Zaragoza, who guided LPA on a tour of the home. There was 3 children present with Licensee when LPA arrived.

The facility operates Monday through Friday from 5:30 AM to 5:30 PM each day. Certain areas are off-limits, including: bedroom 1-3, kitchen, garage, front yard, side of backyard. The facility is licensed as a small Family Child Care Home (FCCH) with a maximum capacity of eight children and is operating within the licensed capacity of the license.

During the inspection, LPA verified a working cell phone is available, and the current phone number/email on file are correct. A fully charged fire extinguisher (2A:10BC) was observed, along with a functioning smoke detector and carbon monoxide detector, both of which were tested by the Licensee. There is no fire place in the home. The hazardous items, such as cleaning products and toxins are stored securely and are inaccessible to children; however LPA did observe medicines in an accessible area. Type B Deficiency issued. No weapons are present, and the Licensee, Ma Del Carmen, understands that all firearms, weapons, and ammunition must be locked separately and made inaccessible as per Title 22 Regulations.

The facility provides clean, safe, and age-appropriate toys for children. A current roster is on file, and required postings, including the Facility Sketch, Emergency Disaster Plan, and Notification of Parent’s Rights, are displayed. Fire and disaster drill documentation are not maintained.

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Gabriela Hernandez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ZARAGOZA FAMILY CHILD CARE
FACILITY NUMBER: 336301086
VISIT DATE: 07/22/2025
NARRATIVE
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There are not any pools, spas, or other bodies of water. Licensee understands that all bodies of water including ponds, above ground pools, spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar products must be emptied immediately after use and stored in an upright position.

Children’s records are complete. Mandated Reporter Training has been completed and is valid until 11/09/2025. The Pediatric CPR and First Aid certification expires on 01/13/2026. Health & Safety Certificate - completed on 03/09/2024. Resident and staff records were reviewed, and all adults requiring caregiver background checks have received the necessary clearances and exemptions.



Licensee Ma Del Carmen 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 Ma Del Carmen 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, an updated Plan of Operation that includes 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: https://www.ada.gov/resources/child-care-centers/

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Gabriela Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ZARAGOZA FAMILY CHILD CARE
FACILITY NUMBER: 336301086
VISIT DATE: 07/22/2025
NARRATIVE
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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.

On-line Licensing forms & regulations for a Child Care Center can be obtained on the Department’s website: www.ccld.ca.gov. 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.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200. Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov Licensee can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov



There are deficiencies being cited on the attached 809-D page.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Ma Del Carmen.

During the exit interview, the Licensee Ma Del Carmen confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 07/07/2025.
*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 inspection, please reach out to me or anyone at the Regional Office (RO). For additional information regarding the inspection and its CARE Tools and methods, please visit the Care Tools webpage at: www.cdss.ca.gov/inforesources/community-care-licensing/process.
NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Gabriela Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/22/2025 01:09 PM - It Cannot Be Edited


Created By: Gabriela Hernandez On 07/22/2025 at 12:29 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ZARAGOZA FAMILY CHILD CARE
FACILITY NUMBER: 336301086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that medicine was stored in an upper kitchen cabinet that does not have a lock or latch therefore accessible to chidlren in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee stated they will put safety lock or latch on the upper kitche cabinet where medicine is stored and send proof to Community Care Licensing (CCL) by the end of the business day on the Plan of Correction (POC) due date of 07/28/2025.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that C1 was sleeing with blankets and pillows which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee stated they will review infant safe sleep regulations and send email to LPA confirming they have read and understand all safe sleep regulations by the end of the business day on the Plan of Correction (POC) due date of 07/28/202
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Pauline Beschorner
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Hernandez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/22/2025 01:09 PM - It Cannot Be Edited


Created By: Gabriela Hernandez On 07/22/2025 at 12:29 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ZARAGOZA FAMILY CHILD CARE
FACILITY NUMBER: 336301086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that C1 was sleeping in the day care room with door closed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee stated they will submit plan indicating how and where C1 will sleep by the end of the business day on the Plan of Correction (POC) due date of 07/28/2025.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Licensee was not documeting sleep log every 15 mintues for C1 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee stated they will send a weeks’ worth of 15 minute sleep documentation for C1 to Community Care Licensing (CCL) by the end of the business day on the Plan of Correction (POC) due date of 07/28/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Pauline Beschorner
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Hernandez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2025


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