364842867-10-31-2023-12-CC-JTAO-CX4TAX-20231030143416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364842867
Report Date: 10/30/2023
Date Signed: 10/31/2023 12:05:48 PM

Document Has Been Signed on 10/31/2023 12:05 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	ZAMORA FAMILY CHILD CARE		FACILITY NUMBER:	364842867
ADMINISTRATOR:	ZAMORA, EORY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 985-3087
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92394
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	10/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:21 PM
MET WITH:	Eory Zamora, Licensee		TIME COMPLETED:	02:50 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	On 10/30/23, Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee Eory Zamora who guided analyst on a tour of the facility for an One Year Required Inspection. Upon arrival LPA observed three (three infants, three preschool) children in care along with one assistant and licensee. This is a two story 4 bedroom, 3 bathroom home with kitchen/dining, family room, living room, formal dining room, laundry room and garage (activity room). There is no pool/spa. There two small decorative fountains at the front walk way area. Days and hours of operation are Monday through Sunday for less than 24 hours. Family members residing in the home include 2 adults (licensee and licensee spouse) and one minor child. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in the living and formal dining rooms (at entrance), family room, and garage (activity room). Children use the bathroom in hallway on the right next to kitchen. Off limit areas include the entire upstairs (Bedroom #2, #3 and #4, bathroom #2 and #3, laundry). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen cabinet, magnet lock), medicines (upper kitchen cabinet, magnet lock) and hazardous items (sharp knives under kitchen sink, magnet lock) that can pose a danger to children. Fire/earthquake drills complete and maintained current: 06/26/2023. Roster complete and maintained current. Stairs have a gate. The home is clean and orderly. The facility entrance is through the front door. There is a designated area for ill children as necessary in the living room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. There are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (land line and cell). All poisons, medication and cleaning items are inaccessible to children, medication in off limits bedroom. Fireplace screened.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 364842867
	VISIT DATE: 10/30/2023

NARRATIVE

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Safe and age appropriate toys, play equipment and materials. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment were observed on the premises. There are age appropriate napping (cots/playpen/crib) equipment. There are no window cords accessible to children.

Bathroom: Shower is free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean and operable.

Kitchen: The home has a clean and fully stocked clean refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch and snacks will be provided. Hazardous items (sharp knives) that can pose a danger to children are inaccessible. Sharp items, plastic bags, cleaning items, no chemicals in the kitchen were observed accessible. Food brought from the children’s home is labelled and dated.

Outdoor: The backyard is completely fenced. There are two separate (gated) play areas and a grassy area for children to play. There is a swing/slide (Little Tikes) that is anchored. There are two dogs (dog run on the left). There is a garden on the left that is also off limits. The right side is gated and off limits to children (emergency use only). There is a barbecue grill. The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises. There is cushioning (grass) material in the play area. There is a gate on the left and right side of the yard.
Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has CPR/First Aid 05/08/2024 and Mandated Reporter 08/15/2024. Review of records to be maintained: LPA reviewed with licensee 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ZAMORA FAMILY CHILD CARE	FACILITY NUMBER: 364842867
	VISIT DATE: 10/30/2023

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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Safe Sleep Log. Licensee stated currently does not have child care insurance.

Licensee 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 Zamora 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.

No deficiencies have been cited at this time.

A notice of site visit was given to licensee and must remain posted 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 Eory Zamora, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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