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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406212735
Report Date: 11/10/2022
Date Signed: 11/10/2022 05:13:39 PM

Document Has Been Signed on 11/10/2022 05:13 PM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ZARATE FCC AKA RISING STARS CHILD CAREFACILITY NUMBER:
406212735
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Martha ZarateTIME COMPLETED:
02:40 PM
NARRATIVE
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On 11/10/2022, at 2:00 PM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced inspection to conduct a Case Management Inspection. When LPA arrived at the Family Child Care Home (FCCH), Licensee and day care children were out picking up one school age child from elementary school. Ten (10) minutes later, Licensee with 5 day care children arrived at FCCH. LPA met with Martha Zarate and discussed the nature of the inspection. LPA asked pre screening questions related to COVID and Licensee's responses indicate there are no COVID-19 exposure on site.

Based on LPA's 10/19/2022 interview with Licensee and Incident Report submitted to Community Care Licensing Division (CCLD) Licensee stated that on Friday, 9/30/2022, on or about 1:40 PM, Licensee was preparing to leave to pick up school age child. Licensee took C1 from the cot and transferred C1 to the stroller and 3 other children. C1 woke up during the transition and was upset. C1 exhibited tantrums and started crying. Licensee attempted soothing C1, she offered bottle, she put blanket to no avail.

On 11/10/2022, Licensee stated that children's nap time is 1:00 PM to 2:00 PM but children do not nap on Thursdays and Fridays because they pick up Child # 2 from school on those days. Licensee added if she observe children are tired she offers the cot to nap however at around 1:40 PM, Licensee and the rest of the child have to pick up C #2 from school.

The following deficiency being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiency cited:

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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Document Has Been Signed on 11/10/2022 05:13 PM - It Cannot Be Edited


Created By: Gigi Reyes On 11/10/2022 at 03:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ZARATE FCC AKA RISING STARS CHILD CARE
FACILITY NUMBER: 406212735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
102423(a)(4)

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102423(a)(4)
(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; ... This requirement is not met as evidenced by:
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Licensee agreed to submit plan of correction to CCL no later than 11/18/2022. gigi.reyes@dss.ca.gov
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Base on Licensee's statement, on 9/30/2022, Licensee transferred napping C1 from cot to the stroller to pick a child from school. This poses a potential risk to health and safety of children 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022


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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ZARATE FCC AKA RISING STARS CHILD CARE
FACILITY NUMBER: 406212735
VISIT DATE: 11/10/2022
NARRATIVE
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Exit interview conducted and report was reviewed with Licensee, Martha Zartae. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

Notice of Site Visit was posted. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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