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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216482
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:42:25 PM

Document Has Been Signed on 11/08/2023 12:42 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:ZACHMANN FAMILY CHILD CAREFACILITY NUMBER:
406216482
ADMINISTRATOR:ALYCIA ZACHMANN / LEGALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 458-6089
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
11/08/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Alycia ZachmannTIME COMPLETED:
12:45 PM
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On 11/7/23, Licensing Program Analysts (LPAs) Elvin Baddley and Francisca Velazquez conducted an announced Prelicense Inspection of the abovementioned home and met with Applicant Alycia Zachmann. LPAs informed Applicant of the nature and purpose of the inspection. Applicant informed LPAs of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 7:00 AM--5:00 PM, Monday- Friday. Applicant also intends to care for children 0 years of age to 12 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD of the given modifications and/or changes. LPAs notes one child (biological) is on site at the time of the inspection.

LPAs, in the company of Applicant, toured the interior and exterior of the homes, in entirety. The property address has two dwellings, a grandmother quarters and the main residential home. The grandmother quarters is a two story dwelling with four bedroom and three bathroom. The grandmother quarter is excluded from care. The main residential home is a two story dwelling with four bedroom and three bathroom. The home's living room, dining room, kitchen, game room, bathroom and backyard will be used for child care services, while the remainder of the home is excluded. An outdoor baseball diamond on the property will be used as a supplemental play area for children in care.



LPAs observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home has a fireplace in the living room which is screened by metal mesh. Additionally, the home has central heating and air vents on the ceiling of the home. The bathroom to be used by children in care is observed to be clean and free of toxins. Cleaning compounds are stored in secure cabinets in the kitchen which are inaccessible to children in care. Sharps and medication are observed in an elevated kitchen cabinet which are beyond the reach of children. The home has working telephone services.

LPAs observed a fire extinguisher (2A10BC) in the home which was purchased on 10/31/23. LPAs reminded

(CONT. 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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 4
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: ZACHMANN FAMILY CHILD CARE
FACILITY NUMBER: 406216482
VISIT DATE: 11/08/2023
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Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a number of smoke and carbon monoxide detectors throughout the home. A smoke detector and carbon monoxide detector located in the residential home's hallway was tested at 11:13 AM and found to be operable.

The backyard area is enclosed by varied fencing (wrought iron and wooden) and the entry/exits gate are secured. Footing in the area is varied. The baseball diamond is fenced and the footing is made of artificial grass. LPAs reminded the Applicant to ensure direct supervision of children in care when traveling beyond the residential home for outdoor activities. LPAs observed no bodies of water on site.

LPAs, record review revealed Applicant's Mandated Reporter training was completed on 3/15/22 (expiration 3/15/24), and Pediatric CPR/First Aid (EMSA approved) was completed on 8/1/23 (expiration 8/1/25). Applicant completed Preventative Health Training on 5/12/22. LPA reminded Applicant of obligation to maintain current training and certifications. The Applicant provided proof of control of property. Applicant does not have liability insurance for the home as of yet. LPAs provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Licensee informed LPAs the home has ammunition and firearms on site. LPAs observed storage of ammunition and firearms and notes the aforementioned is stored separately and inaccessible to children in care. There four dogs on site. LPAs reviewed the vaccination records for the dogs which were current.



LPAs reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.



LPAs discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep

(CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ZACHMANN FAMILY CHILD CARE
FACILITY NUMBER: 406216482
VISIT DATE: 11/08/2023
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as an additional resource. LPAs also informed Applicant 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 they register all infant devices with the CPSC to be notified of any recalls of infant devices or their purchased equipment.

Applicant 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

On this date, 11/7/23, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



Exit interview conducted and report was reviewed with the Applicant Alycia Zachmann. The home received a fire clearance from Cal Fire for a capacity of 14 on 8/1/23. The home does not meets Title 22 Division 12 requirements of a Large (14) FCCH License at this time as licensure is pending the clarification of the (CONT.809-C, Page 4)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ZACHMANN FAMILY CHILD CARE
FACILITY NUMBER: 406216482
VISIT DATE: 11/08/2023
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control of property and an Administrative Review.. Moreover, the entire access of the property's grandmother quarters in need pending licensure.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4