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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073402716
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:32:12 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2024 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20240110155623
FACILITY NAME:SALAZAR, CARMENFACILITY NUMBER:
073402716
ADMINISTRATOR:SALAZAR, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 848-7251
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 4DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Carmen SalazarTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Facility fence is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to investigate the above allegation. LPA met with Carmen Salazar.

LPA inspected the backyard fence. The backyard is fully fenced, however there are 4 fence boards that are loose. The top of the boards are attached to the fence. The bottom of the boards are loose and are able to be pushed back away from licensee's yard which creates a small opening.
Based on LPAs observation, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Exit interview and report reviewed with Carmen Salazar.
Notice of Site Visit was provided and must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 02-CC-20240110155623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SALAZAR, CARMEN
FACILITY NUMBER: 073402716
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2024
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
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Licensee shall ensure all fence boards are secured. The backyard shall be off limits to children in care until the fence is secured. Licensee shall submit a letter to CCL by 1/15/24 ensuring the fence is secured.
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This requirement was not met as evidenced by: The backyard fence has loose boards which is a potential risk to the health and safety of children in care.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
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