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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434413431
Report Date: 12/14/2022
Date Signed: 12/16/2022 09:13:56 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2022 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221017095609
FACILITY NAME:ZAMUDIO, MICHAELFACILITY NUMBER:
434413431
ADMINISTRATOR:ZAMUDIO, MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 227-0640
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: DATE:
12/14/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Michael ZamudioTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Provider forced children to help with inappropriate tasks.

Provider forced children to exercise in an inappropriate manner.

Day care children has access to sharp objects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janette Cruz conducted an unannounced complaint investigation and met with Michael Zamudio, Licensee. Purpose of today’s inspection: deliver investigation findings. LPA also observed two infants, two preschool children, Licensee's spouse/staff Jennifer Zamudio and Licensee's niece/staff, Lyneth Zamudio, present at the facility during today's complaint investigation. LPA toured indoor and outdoor areas of the home.

Based on observations, record reviews and interviews conducted, it was discovered that per allegation provider forced children to help with inappropriate tasks, such as taking out the trash and picking up dog’s feces. It was also discovered that provider forced children to do inappropriate exercises such as performing push-ups as form of discipline. During today's visit, LPA observed objects with sharp edges such as rolled fenced wire, metal strip and a rake accessible to the children located at the backyard. The preponderance of evidence standard has thus been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC 9099-D. Copy of appeal rights provided to Michael Zamudio, Licensee, prior to conclusion of today’s inspection.


A Notice of Site Visit is issued and must be posted near the entrance of the facility along with a copy of today's report for 30 days.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20221017095609
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ZAMUDIO, MICHAEL
FACILITY NUMBER: 434413431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2022
Section Cited
CCR
102423(a)(1)
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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(1) To be treated with dignity in his/her personal relationship with staff and other persons.

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Licensee stated that they will no longer ask children to do inappropriate tasks such as picking up dog feces and taking out trash. Licensee will also submit to LPA Cruz a proof of review by all staff regarding Personal Rights by POC due date.
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Based on interviews and record reviews, Licensee did not comply with the section cited above. Licensee forced children to help with inappropriate tasks such as taking out the trash and picking up dog’s feces which posed a potential health, safety or personal rights risk to persons in care.
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Type B
12/28/2022
Section Cited
CCR
102423(a)(4)
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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.


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Licensee will submit a proof of training conducted for all staff regarding proper discipline. Licensee will also submit a written plan of type of discipline and type of exercises appropriate for children in care by POC due date.

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Based on interviews and record reviews, Licensee did not comply with the section cited above. Licensee forced children to exercise in an inappropriate manner such as doing push-ups as form of discipline which posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20221017095609
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ZAMUDIO, MICHAEL
FACILITY NUMBER: 434413431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/14/2022
Section Cited
CCR
102417(g)4)
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102417 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 be 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.
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Licensee immediately barricaded the right side of the yard where items with sharp edges were observed.
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Based on observation on today's visit, Licensee did not comply with the section cited above. LPA observed objects with sharp edges such as rolled fenced wire, metal strips and a rake accessible to the children at the backyard which posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3