198400386-8-10-2021-54-CC-KCHE-C5RNV5-20210810104721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400386
Report Date: 05/14/2021
Date Signed: 08/10/2021 10:47:34 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	SALAZAR FAMILY CHILD CARE		FACILITY NUMBER:	198400386
ADMINISTRATOR:	NELY SALAZAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 866-9318
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 0	DATE:	05/14/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Nely Salazar, Applicant		TIME COMPLETED:	09:40 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	This was a pre-licensing inspection conducted by Katrina Chicote, Licensing Program Analyst (LPA) on 05/04/2021 at 8:57 AM. Due to COVID-19 and precautionary measures, this pre-licensing was conducted via tele-inspection using Zoom Meeting with Nely Salazar, Applicant. Applicant guided LPA on a virtual tour of the facility. During inspection, individuals who reside in the home were discussed and noted. The Applicant is requesting a large family child care home license. Fire clearance is pending at this time Per Applicant, operation hours will be Monday to Friday, 8:00AM to 6:00PM and Applicant states that she will care for children 0-9 years of age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home with three bedrooms, two bathrooms, living room, den, kitchen, and dining room. There is an operable phone working at the facility. Per Applicant, the children will have access to dining room, den, Bathroom 1, and the Kitchen. Areas that will be used by children were inspected for safety, comfort, cleanliness, and ventilation and heating (ceiling fans). Main Care Area will be the den, which is located in the rear of the home, as well as dining room area. Applicant states that children will walk through backyard area and use backdoor entry for main entrance to facility.At 9:00 AM, LPA observed outdoor play area, which is the reception area for the children. LPA observed age appropriate toys such as plastic play structure, plastic ride along and push toys, water and sensory tables, and other toys free of lose and sharp parts available for children in care. Upon entry to the home, you walk into Main Care Area of the day care. At 9:01 AM, LPA observed cubbies for children's belongings, carpets through out, a circle time area with day care posters, tall wooden doll house, play kitchen, books, and other toys free of lose and sharp parts. At 9:03 AM, LPA was toured Bathroom 1, located down the hallway to the left, which will be used by children in care. At 9:04 AM, LPA observed operable child safety locks under sink cabinets, and unlocked medicine cabinet to contain toothbrushes and toothpaste. At 9:04 AM, LPA observed disinfectant cleaner on Report Continues Next Page - Page 1 of 5

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SALAZAR FAMILY CHILD CARE	FACILITY NUMBER: 198400386
	VISIT DATE: 05/14/2021

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window sill in Bathroom 1 making it accessible to children in care. LPA advised Applicant that any disinfectant cleaners needs to be made in accessible to children in care, Applicant states that she will store cleaners and other hazardous items in her Bedroom, which is an off limits area. At 9:05 AM, LPA observed Applicant remove cleaner from window sill and place in off limits area. Per Applicant, she has ordered mats that will be used for napping. Kitchen will be accessible to children only as a walkway. At 9:07 AM, LPA observed gates blocking entrances to the kitchen separating Main Care Area from Kitchen. The Dining Room, through the Kitchen, will also be part of Main Care Area. LPA observed carpet and table in Main Care Area. Applicant states Main Care Area will also be used for eating and napping. Per Applicant, she will be providing food for children in care. At 9:08 AM, LPA also observed a standard wooden crib that has not yet been assembled, Applicant states that this will be used for napping infants. At 9:09 AM, LPA observed Kitchen to have operable child safety locks on cabinets. LPA observed sharp knives and utensils are kept in locked cabinet drawer in the Kitchen, making it inaccessible to children in care.

Based on the Facility Sketch submitted, areas off limits to children are all three bedrooms, Bathroom 2 (located in Applicant's Bedroom), and Living Room. Per Applicant, all bedrooms will be locked during operating hours. At 9:11 AM, LPA observed child gates with locks blocking Living Room from rest of the home, making area off limits. The Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Per Applicant, there are no pets, firearms, or weapons in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Applicant states that there are no poisons in the home. Applicant does understand that poison must be locked with a key or combination lock.

At 9:07 AM, LPA Chicote observed a 2A10BC fire extinguisher in the home located in walkway by the kitchen, there is also a second fire extinguisher hanging in Main Care Area. LPA notified Applicant that fire extinguisher must be serviced annually to make sure that is in operable working condition. At 9:10 AM, LPA Chicote observed operating smoke detector and carbon monoxide monitor. Applicant states that they have ordered a First Aid Kit but it has not yet come in. The Applicant has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Applicant has also taken the Mandated Reporter Training
—CPR Card valid until: 01/2023
—Mandated Reporter AB1207 Completed: 02/23/2021

Report Continues Next Page - Page 2 of 5

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SALAZAR FAMILY CHILD CARE	FACILITY NUMBER: 198400386
	VISIT DATE: 05/14/2021

NARRATIVE

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The following was discussed with the Applicant during teleinspection:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department for a minimum of 3 years.
· No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.
Report Continues Next Page - Page 3 of 5

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SALAZAR FAMILY CHILD CARE	FACILITY NUMBER: 198400386
	VISIT DATE: 05/14/2021

NARRATIVE

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Infant Care: Applicant states that they will care for infants. LPA advised the applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

The following forms were discussed and mailed to the Applicant on 11/12/2020:
CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149).

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following:
Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC
Report Continues Next Page - Page 4 of 5

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SALAZAR FAMILY CHILD CARE	FACILITY NUMBER: 198400386
	VISIT DATE: 05/14/2021

NARRATIVE

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9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Based on LPA's observation today, 05/14/2021, upon confirmation of fire clearance being granted, LPA will submit to Manager for review and approval for a large family child care home license. Pending approval, once licensed, the Applicant is required to comply with the terms and limitations stated on the license.

Exit interview was conducted with Applicant, Nely Salazar, on 05/14/2021 at 9:57 AM. Due to COVID19 and precautionary measures, a copy of the report was emailed to Applicant with 'Read' receipt on which acts as the digital signature acknowledging receipt of the report.

Report Ends - Page 5 of 5

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

LIC809 (FAS) - (06/04)

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