<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311174
Report Date: 12/03/2024
Date Signed: 12/03/2024 11:19:32 AM

Document Has Been Signed on 12/03/2024 11:19 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ZEPEDA, GLADYSFACILITY NUMBER:
304311174
ADMINISTRATOR/
DIRECTOR:		ZEPEDA, GLADYSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 869-5094
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee, Gladys ZepedaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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
Licensing Program Analysts (LPA) Cynthia Sun conducted an unannounced case management inspection in response to a self-report Unusual Incident dated 11/20/2024. LPA met with Licensee, Gladys Zepeda. Census was taken as follows: 2 staff supervising 6 children: 3 infants and 3 preschool children playing with toys in childcare room.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 11/20/24, Regional Office received a self-reported Unusual Incident Report (UIR) stating Staff # 1 (S1) found Child #1 (C1) with pants down and Child #2 (C2) was rubbing/scratching C1’s bottom over C1’s underwear. On 11/19/24 Licensee informed C1's and C2 parents of incident. C1 informed Parent #1 (P1) that C2 pulled down C1 pants and C2 touched C1’s bottom.


During today's inspection, LPA inspected facility, interviewed staff and children, obtained facility children roster.

Due to insufficient information available at this time, the reported incident needs further investigation.



PAGE 1 OUT OF 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ZEPEDA, GLADYS
FACILITY NUMBER: 304311174
VISIT DATE: 12/03/2024
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
26
27
28
29
30
31
32
No deficiency was observed during today's inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The licensee was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door.


PAGE 2 OUT OF 2

END OF REPORT

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2