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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311174
Report Date: 12/11/2024
Date Signed: 12/11/2024 09:14:58 AM

Document Has Been Signed on 12/11/2024 09:14 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: 8DATE:
12/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee, Gladys ZepedaTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Cynthia Sun conducted an unannounced follow-up case management inspection in response to a self-report Unusual Incident dated 11/19/24. LPA met with Licensee Gladys Zepeda and informed purpose of today’s case management initiated on 12/03/24. Census was taken as follows: 2 staff supervising 3 infants and 5 preschool children in the 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 11/19/24, Regional Office received a self reported Unusual Incident Report (UIR) stating on 11/19/2024, Staff # 1 (S1) was outside in the backyard supervising 4 children washing hands to return to lunch. Child #1 (C1) and Child # 2 (C2) ran off and S1 went after them. S1 found C1 had the pants down and C2 was rubbing/scratching C1’s bottom over C1’s underwear.

On 12/03/24, LPA interviewed S1 who stated the following: On 11/19/24, S1 was in the backyard helping four children wash hands in outside sink when C1 and C2 ran from S1 to play in the backyard. S1 was unable to go after C1 and C2 because S1 already put soap on the other two children’s hands and S1 needed to finish washing their hands. It took S1 about three minutes to finish helping the other 2 children washing their hand and S1 went toward C1 and C2 immediately. S1 observed C1 was lying flat on stomach with pants down and C2 was patting C1’s bottom over underwear. S1 helped C1 put the pant up and S1 called out for S2 to come out of facility to talk to C1 and C2.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ZEPEDA, GLADYS
FACILITY NUMBER: 304311174
VISIT DATE: 12/11/2024
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LPA also interviewed Staff #2 (S2) and Staff #3 (S3). Both staff provided the same information as S1.

LPA observed backyard with sink is on side of facility where children wash hands. LPA confirmed facility backyard has locked gates making street inaccessible to children in care.

LPA interviewed P1 and Parent #2(P2). P2 stated S2 told P2 that C2 touched C1’s bottom. P2 stated C2 saw something similar in a Sonic video on tablet at home. There is a Sonic video where Sonic runs and spanks another character on their bottom. P2 has taken tablet from C2 to prevent C2 from watching anymore Sonic videos. P1 stated still feeling uneasy about incident, but is willing to continue having C1 attend childcare. P1 is calling childcare throughout day checking in on C1.

Based on LPA’s interviews and observation, it was determined the facility was in compliance with regulation and no citation was being issued.

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

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ZEPEDA, GLADYS
FACILITY NUMBER: 304311174
VISIT DATE: 12/11/2024
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Exit interview conducted and report was reviewed with Licensee Notice of Site Visit was posted and must remain posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights were explained. The licensee was provided with a copy of the appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

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

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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