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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406183
Report Date: 07/14/2023
Date Signed: 07/17/2023 12:09:39 PM

Document Has Been Signed on 07/17/2023 12:09 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ZAMORA, HILDAFACILITY NUMBER:
444406183
ADMINISTRATOR:ZAMORA, HILDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-1816
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
07/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Hilda ZamoraTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced 1 year required inspection to the home today. LPA met with Licensee, Hilda Zamora and explained the nature of today's inspection to her. Also present during the inspection was Licensee's assistant, Ana Zamora and 6 day care children (4 preschoolers and 2 school age). Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Licensee states there are 4 adults living in the home; Licensee, her brother (Carlos Zamora) and two sisters (Ana and Lela Zamora). Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA inspected the indoor and outdoor area of the family child care home. Off limit areas in the home are three bedrooms, laundry room, and detached storages in the backyard. No bodies of water observed. Licensee states there are no firearms or other dangerous weapons in the home. Detergents, cleaning compounds, medication, and other items which could pose danger to children are stored where they are inaccessible to children. Licensee understands that poisons are to be locked. No fireplaces or open face heaters in the home. The fire extinguisher (2A10BC) and smoke detector meet state fire marshal standards and was serviced on 02/21/23. The carbon monoxide detector was tested and proved to be functioning and meets the statutory requirements. Last practiced fire drill was on June 9, 2023.

LPA observed the home to be clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. LPA observed safe toys, play equipment, and materials. LPA reviewed facility roster. Licensee has a working telephone and provider her cell number, (831) 498-0117.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ZAMORA, HILDA
FACILITY NUMBER: 444406183
VISIT DATE: 07/14/2023
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LPA reviewed nine (6) children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records. Licensee carries day-care insurance.

LPA reviewed Licensee's and Assistant (Ana Zamora) file. Licensee has immunization's for measles, pertussis. Licensee's Mandated Reporter Training expires 01/21/24 . LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. Licensee has CPR and First Aid expires on 01/22/24. Licensee's Assistant (Ana Zamora) has current CPR & First Aid expiring 01/21/24. Assistants Mandated Reporter Training expires on 01/21/24. Licensee and Assistant have a signed paper stating they declined the influenza vaccine this season. Ana Zamora has immunization against measles and pertussis.

LPA provided and discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also reminded Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended she registers all infant devices with the CPSC to be notified of any recalls on her purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Continuation on next page:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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: ZAMORA, HILDA
FACILITY NUMBER: 444406183
VISIT DATE: 07/14/2023
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Licensee, Hilda Zamora was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

As a result of today's inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with Licensee, Hilda Zamora.


A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3