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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842867
Report Date: 02/14/2022
Date Signed: 02/14/2022 11:45:46 AM

Document Has Been Signed on 02/14/2022 11:45 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ZAMORA FAMILY CHILD CAREFACILITY NUMBER:
364842867
ADMINISTRATOR:ZAMORA, EORYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 985-3087
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
02/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Eory ZamoraTIME COMPLETED:
12:01 PM
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Licensing Program Analyst (LPA) Thompson-Miller, met with Licensee, Eory Zamora for a Case Management Incident inspection involving an Incident Report dated February 2, 2022. The incident occurred on February 1, 2022. Present are 3 infants and 9 toddlers,

Description of the incident: Foster Child allege licensee spouse pushed him.
Licensee spouse asked Child to put away the dishes from drain (1/23/22). Child got upset. Child got in trouble at school (1/21/22). Child got up and made accusation regarding Foster parent (licensee spouse). Adoption Social Worker interviewed Child on 2/1/22.
Licensee stated no day care children or staff were present during the incident (occurred on the weekend). Interview conducted with Licensee.
There is a cross report with the San Bernardino County CPS.

Based on the interview conducted the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore, no deficiencies were cited

An exit interview was conducted and a copy of this report was read and provided to licensee, Eory Zamora on this date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2022
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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