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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494371
Report Date: 05/26/2023
Date Signed: 05/26/2023 11:30:32 AM

Document Has Been Signed on 05/26/2023 11:30 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ZAVALETA FAMILY CHILD CAREFACILITY NUMBER:
197494371
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/26/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maritza ZavaletaTIME COMPLETED:
11:45 AM
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On May 26, 2023 at 10AM., Licensing Program Analyst (LPA) Veronica Wheatley conducted an announced case management inspection for an increase in capacity from 8 to 12 children. LPA met with licensee Maritza Zavaleta. LPA did not observed any day care children present today. The parents enter through the side gate to the rear. LPA observed all required forms posted at the entrance. Hours 7:30am to 5:00pm.

LPA Wheatley toured the entire inside and outside of the home. The home is a very clean with three bedrooms, two bathroom house. The primary day care shall be conducted in the den with sliding doors. However the licensee is allowed to use the living room and dining room. All bedrooms are inaccessible to the children. The home is equipped with central heating and air conditioning. LPA observed age appropriate toys, cubbies and age appropriate equipment. The children's equipment will be kept separate and individual. LPA observed cots and a first aid kit. The kitchen is off-limits. LPA observed child proof locks on the kitchen and bathroom cabinets. Licensee was informed the importance of this safety and regulation. LPA observed a large backyard with grass and a paved area. The outdoor area is safe and there are no bodies of water or pets on the premises. The fireplace in the den is screened and locked properly. Per licensee, there are no firearms on the premises.

LPA Wheatley observed the following:
*Fire safety requirements: Fully charged fire extinguisher (Classification: 2A10BC), smoke and carbon monoxide detectors present and operable. The licensee is conducting fire and earthquake drills.
*Mandated Reporter Training is current expires November 2023. Children's records were reviewed and are current.
*Licensee currently certified in Pediatric CPR/First Aid and has completed the preventive health and safety training, and childhood nutrition training. Expires 8/2024.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZAVALETA FAMILY CHILD CARE
FACILITY NUMBER: 197494371
VISIT DATE: 05/26/2023
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*Toys and equipment are observed and in good repair
* The home is equipped with a first-aid kit: Cleansing pads, band aid, bandages, gauze, and a digital thermometer
*Child proof electrical outlets were observed.

The following items were thoroughly discussed with the applicant:
*Licensee was informed infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome) Licensee was informed that all provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials19-02 CCP Safe Sleep Awareness Campaign

*Mandatory Forms for the children’s files. Records must be kept for 3 years after termination.


*Licensee was referred to LIC 311D: Records to be Maintained at The Facility - Family Child Care Home.
*Licensee was made aware that it is their responsibility, as well as anyone who assists in providing care, to know Title 22 Regulations.
*Regulation prohibits the smoking of tobacco on the premises
*State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category

Licensee states she does not have any children receiving IMS services. Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee has the required licensing forms posted.

LPA did not observe any Title 22 Regulation deficiencies. A fire clearance has been received by the Department. A license for 12 capacity will be granted. The licensee does not have Landlord Consent for 14.

Exit interview conducted and copy of report provided.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
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