013411827-10-12-2022-52-CC-RHAR-CK5PTS-20221012113625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013411827
Report Date: 10/12/2022
Date Signed: 10/12/2022 11:36:34 AM

Document Has Been Signed on 10/12/2022 11:36 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SALSEDO, RACHEL AND TIMOTHY		FACILITY NUMBER:	013411827
ADMINISTRATOR:	RACHEL SALSEDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 377-5783
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	12	CENSUS: 6	DATE:	10/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Rachel and Tim Salsedo		TIME COMPLETED:	11:45 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On October 12, 2022 at approximately 9:20am Licensing Program Analyst (LPA) Russ Haderer arrived for the annual inspection for health and safety. Present for the inspection was licensee Rachel Salsedo and her fingerprint cleared co-licensee husband Tim Salsedo and 6 children in care (3 infants, 1 three-years old and 2 four-years old). The facility is in ratio today. The hours of operation remain at 8:00am to 4:30pm.

The facility is a 3 bedroom, 3 bath single family home with a front and back yard area and an attached 2-car garage.

ISOLATION AREA will be in the front living room on a mat away from other children in care until their parents can come and pick them up.

On-limit-areas include: On-limit-areas include: Living room, kitchen (eat-in dining room area); Daycare room, 1`/2 bathroom in the daycare area, and backyard patio area. Licensee reminded that other than wipes or things used for the children in the on limits bathroom, they need to be empty of most all items (or locked up) cleaning products etc. The kitchen has appropriate latches for safety mounted on all cupboards within the children's reach. There were no hazardous items in any drawers or cupboards.

Off-limit-areas include: All three bedrooms (including the house bathroom and bathroom in master bedroom) and attached 2-car garage. The front yard is off-limits, as well as the side yards accessible from the back yard. The off-limit areas will be inaccessible by closed and/or locked doors, or child gates.

There is a fully charged 3A40BC fire extinguisher located in the daycare area. The facility has a working (tested) dual smoke and carbon monoxide detectors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills monthly, the log indicates the last drill was conducted 10/02/2022. Required licensing documents are posted and visible.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SALSEDO, RACHEL AND TIMOTHY	FACILITY NUMBER: 013411827
	VISIT DATE: 10/12/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There were ample age appropriate toys that were observed to be safe and in good condition. The home is neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

Children's files were reviewed, all records were complete and in good order. Infants in care from age birth to 12 months had complete and signed LIC9227 Infant Sleeping Plans, safe sleep observation logs are maintained with 15-minute checks documented for all infants up to 24 months in care. The facility roster was reviewed, and a copy obtained.

The licensee’s Pediatric CPR/First Aid certificate is current and expires 6/2023. Mandated reporter training completed 4/7/2021(Tim), Rachel’s mandated reporter just expired on 9/4/2021. Licensee, and all adults living in the home are in compliance with immunization laws which pertains to day care providers. LPA reminded the licensee that CPR/1^st Aid and Mandated Reporter training is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

The licensee owns the property, property tax statement provided as proof. Licensee does not carry liability insurance, signed and dated acknowledgement form LIC282 in each child’s file.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SALSEDO, RACHEL AND TIMOTHY	FACILITY NUMBER: 013411827
	VISIT DATE: 10/12/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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 they register all infant devices with the CPSC to be notified of any recalls on their 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/inspection-process.

There were no deficiencies issued today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensees Rachel Salsedo.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3