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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415554
Report Date: 07/15/2021
Date Signed: 07/20/2021 10:46:06 AM

Document Has Been Signed on 07/20/2021 10:46 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FARFAN DE ZAMORA, CONSUELOFACILITY NUMBER:
274415554
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Consuelo Farfan De ZamoraTIME COMPLETED:
02:00 PM
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fourLicensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Consuelo Farfan De Zamora for an unannounced Required – 1 year annual inspection and increase in capacity inspection. LPA observed four day care children ( 4 preschoolers) and Licensee's adult son (Raul Zamora) in the home during today's inspection. The Licensee was operating within her capacity and ratio requirements during today's inspection. LPA observed the required postings, including the facility license, near the front entrance to the home. The home has a working cell phone number (831) 740-9198. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The Licensee and her spouse, Raul Zamora, her two adult children, Raul Zamora Jr and Briannna Zamora Farfan are the adults residing in the home. Licensee has a 16 year old daughter.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 07/06/2021. The Licensee has the required vaccinations (MMR, Tdap). Licensee states that she obtained the flu shot at her church this year but does not have proof. The Licensee's CPR and First Aid are current and expire on 06/18/2022.

The Licensee has current Mandated Reporter Training for Child Care Workers on file (exp: 03/15/2022). Licensee's son is assisting Licensee today. LPA reviewed the file for Raul Zamora Jr. - Raul Jr. needs to complete the Mandated Reporter Training.
LPA reviewed four children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee states that a child will be isolated in the living room area if needed to because of illness or communicable disease.

REPORT CONTINUED ON FOLLOWING PAGE #2 - REPORT DATED 07/15/2021):
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: FARFAN DE ZAMORA, CONSUELO
FACILITY NUMBER: 274415554
VISIT DATE: 07/15/2021
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/15/2021):
LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled.
There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. The two wall heaters are barricaded. The off limits area in the home are three bedrooms and hall closets. The detached rooms in the back yard are off limits. One is used for storage and the other one is a study room for her son. Both were closed and locked during today's inspection. The garage is off limits to children and is only used as a passage to the backyard. The backyard is fenced. Licensee has a small fountain outside next to the front entry door. LPA advised Licensee today to fill it to the top with rocks - without water.
The smoke/carbon monoxide detectors were tested and proved to be functioning. LPA observed a 3A40BC fire extinguisher that needs to be charged inside of the home; Licensee has a 3A40BC fire extinguisher outside that is fully charged. LPA asked Licensee to bring the extinguisher that is outside, inside. The Licensee states that she does not have any pets and weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee understands that any poisons are to be locked and out of the reach of children.

A review of staff records on July 13, 2021 indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Licensee's daughter, Brianna Zamora Farfan (4600010641) has a pending status on LIS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FARFAN DE ZAMORA, CONSUELO
FACILITY NUMBER: 274415554
VISIT DATE: 07/15/2021
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Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time. The Licensee states that does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA conducted an exit interview with the Licensee and advised her that before a large license (capacity 14) can be approved the following is required:

1. Approval from Fire Department

2. Fingerprint Clearance for 18 year old daughter, Brianna Zamora Farfan. Licensee has a clearance letter from CBCB but daughter shows pending on LIS today.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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