ZAMBRANO FAMILY CHILD CARE

Based on file review Licensee, S1, S2 missing proof: LIC 9052 which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on record review, Licensee, S1, and S2 missing proof of MMR, TDAP, Influenza and TB clearance which poses a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on record review, C3, C4 are missing proof the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on record review Child (C) C3 were missing proof, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, Child (C) C1, C2, C3 were missing proof of Safe Sleep Plan documentation. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPAs) Fabiola Vasquez and Steven Tung conducted an unannounced required inspection at the above facility on 03/28/22 at 12:30 PM. Visit was conducted in Spanish. LPA met with Salome Zambrano, Licensee who guided analyst on a tour of the facility at approximately 12:35 PM. There were 4 children (3 being infants) present adults were Licensee, S1,S2,S3 present upon arrival. Facility capacity is in compliance for a Large Family Child Care Home. Per licensee 4 adults and 3 minors live reside in the home. This is a one-story home which consists of three bedrooms, one restroom, kitchen, dining room, Living room, shed, detached garage, front and back yards (fenced). Per Licensee, areas off limits to children and parents include: the bedrooms, detached garage, and shed. Hours of operation are Mon-Fri 6:00 AM - 6:00PM. Food is provided by Licensee. LPAs observed bird cages in the backyard inaccessible to children. LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. Last drill was conducted on 2/20/22. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed a wall heater in the living room (screened). LPA observed that detergents, cleaning compounds and medication are stored in in an area that is inaccessible to children. LPAs observed a can of Lysol, 2 Clorox containers and a Clorox spray accessible to children. Licensee understands that all poisons must be lock. Isolation area for sick children waiting to be picked up is away from the other children. Per Licensee there are no firearms or weapons stored in the home. PAGE 1 OF 3 SUPERVISORS NAME: Claudia Guangorena LICENSING EVALUATOR NAME: Fabiola Vasquez LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022 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 9 FACILITY NAME: ZAMBRANO FAMILY CHILD CARE FACILITY NUMBER: 198008599 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/28/2022 DEFICIENCIES & PLANS OF CORRECTION (POCs) Type BSection CitedCCR102417(b) Operation of A Family Child Care Home (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidenced by: Deficient Practice Statement 1 2 3 4Based on observation, LPAs observed in the dinning area stalked up papers, containers used for storage. Plastic containers on top of a shelf in the play area, plastic bags with items inside which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/04/2022 Plan of Correction 1 2 3 4Per Licensee will submit proof to LPA by POC date: Type BSection CitedCCR102417(g) Operation of A Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: This requirement is not met as evidenced by: Deficient Practice Statement 1 2 3 4Based on observation, LPAs observed in the a television screen on top of the entertainment center. Wires drapping from outlets. Plastic bags accessible to children. POC Due Date: 04/04/2022 Plan of Correction 1 2 3 4Per Licensee will submit proof to LPA by POC date: 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:Claudia Guangorena LICENSING EVALUATOR NAME:Fabiola Vasquez LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022 FACILITY NAME: ZAMBRANO FAMILY CHILD CARE FACILITY NUMBER: 198008599 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/28/2022 DEFICIENCIES & PLANS OF CORRECTION (POCs) Type BSection CitedCCR102417(g)(4)(A) Operation of A Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on file review Licensee, S1, S2 missing proof: LIC 9052 which posesa potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on observation, LPAs observed in the dinning area stalked up papers, containers used for storage. Plastic containers on top of a shelf in the play area, plastic bags with items inside which poses a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on observation, LPAs observed in the a television screen on top of the entertainment center. Wires drapping from outlets. Plastic bags accessible to children.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on observation, LPAs observed a Lysol spray , 2 clorox wipes conatiners and clorox spray in the restroom accessible to children which poses a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date:

Based on LPAs observation. LPAs observed loose blankets inside the crib which poses a potential health, safety or personal rights risk to persons in care.

Resolution: Per Licensee will submit proof to LPA by POC date: