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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623731
Report Date: 01/26/2023
Date Signed: 01/26/2023 04:22:44 PM

Document Has Been Signed on 01/26/2023 04:22 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ZGAER, BANFACILITY NUMBER:
343623731
ADMINISTRATOR:ZGAER, BANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 255-3475
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ban ZgaerTIME COMPLETED:
04:45 PM
NARRATIVE
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On January 26, 2023 Licensing Program Analyst (LPA) Lea Habtom met with Licensee, Ban Zgaer, for the purpose of an unannounced required 1-year inspection. Licensee assistant, son and spouse were present in the home during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed a total census of 14 children including 3 infants over 12 months, 2 infant under 12 months and 9 preschool children being supervised by licensee and her assistant.

Licensee guided LPA on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Off-limits areas includes the main entire main home. The day care is being operated in the converted garage only. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. LPA did not observe bodies of water at the facility. Toxic and hazardous items are inaccessible to children. There is no fireplace is barricaded to prevent access by children. There are no stairs in the home Outdoor play space is fenced.

Licensee 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 reviewed children’s files. A current roster is being maintained and fire and disaster drills are documented. The licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current CPR and First Aid certification was verified and expires 2/10/2023 and mandated reporter training is waived due to language barrier for license. Licensee's assistant does not have mandated reporter training. (Report continues LIC809-C)
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ZGAER, BAN
FACILITY NUMBER: 343623731
VISIT DATE: 01/26/2023
NARRATIVE
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Infants are enrolled at this time. LPA observed three play yards at the facility. Play yards had blankets with napping infants in it. A recalled item, the boppy lounger, was being used for an awake infant. LPA reviewed infant sleep plan (LIC 9227) requirement with Licensee however 15-minute observation checks of napping infants are not being documented.

LPA discussed the safe sleep regulations with licensee 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 Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. 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)/(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

Title 22 Deficiency has been cited on the attached LIC 809-D. LPA Lea Habtom informed licensee Ban Zgaer that this report dated January 25, 2023 document(s) 4 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Lea Habtom informed the licensee Ban Zgaer to provide a copy of this licensing report dated January 26, 2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Appeal Rights given.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, regulations, current forms, Provider Information Notices (PINs), and to subscribe to quarterly updates

Exit interview conducted and report was reviewed with the licensee Ban Zgaer. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. To improve the quality and value of the new inspection process, a survey will be sent to the email address
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 01/26/2023 04:22 PM - It Cannot Be Edited


Created By: Lea Habtom On 01/26/2023 at 03:23 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ZGAER, BAN
FACILITY NUMBER: 343623731

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(d)(1)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials. (1) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used for children in care or accessible to children in care.

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 a boppy sleeper was being used for an awake infant who ended up falling asleep which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Licensee removed the boppy sleeper and was made aware to not use any recalled items in the day care. Licensee was advised to check for recalled items.
Type A
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 two infants were in pack n plays with blankets which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Licensee removed the blankets and was made aware that infants in pack and plays may not have blankets.
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:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/26/2023 04:22 PM - It Cannot Be Edited


Created By: Lea Habtom On 01/26/2023 at 03:23 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ZGAER, BAN
FACILITY NUMBER: 343623731

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(h)
Infant Safe Sleep
Car seats shall only be used for transportation purposes and shall not be used for sleeping.

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 an infant was sleeping in a car seat with a blanket on top which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Licensee was made aware that infants cannot sleep in car seats and must be moved into an approved sleep environment once asleep.
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

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 there were 5 infants and 14 children with no school age which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Licensee was advised of ratio guidelines and one infant was picked up while LPA was present. Licensee made parents aware that she can no longer care for that infant until one child turns two.
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:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/26/2023 04:22 PM - It Cannot Be Edited


Created By: Lea Habtom On 01/26/2023 at 03:23 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ZGAER, BAN
FACILITY NUMBER: 343623731

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that licensee is not documentating the nap checks which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2023
Plan of Correction
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Licensee agreed to email LPA L. Habtom copies of the nap checks by POC date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the assistant did not have mandated reporter training completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2023
Plan of Correction
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Licensee agreed to email LPA L. Habtom a copy of the mandated reporter training for her assistat 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:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
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