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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310443
Report Date: 07/08/2019
Date Signed: 07/08/2019 10:34:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SALCEDO, LORENAFACILITY NUMBER:
304310443
ADMINISTRATOR:SALCEDO, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 313-1557
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY:14CENSUS: 8DATE:
07/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Lorena Salcedo, LicenseeTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Yesenia Villa and Eileen Corral conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPAs met with Lorena Salcedo, Licensee. LPAs toured the facility inside and outdoors. There were 8 children present in the home upon arrival, one of which is an infant. Assistant Lorena Salcedo was also present during today’s inspection. The facility was observed to be within ratio during todays visit.

Per Licensee there are 4 adults residing in the home. Licensee’s operating hours are Monday through Saturday from 5:00am-6:00pm. All adults residing in the home are fingerprint cleared. Per Licensee she has 12 children enrolled in the day care. An updated roster was available during the inspection.

The home is a single-story home with 3 bedrooms and 1 ½ bathrooms. The following areas used for day-care: are the living room, dining room, backroom and the ½ restroom located next to the front door. The three bedrooms, full bathroom located in the hallway and kitchen are off limit areas for the children. The off limit areas are closed by a baby gate closing off the hallway access to the children. The garage is also an off limit area. It is a detached garage located in the front of the house. The Licensee was reminded that full supervision is required at all times to ensure children do not have access to the off-limit areas.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SALCEDO, LORENA
FACILITY NUMBER: 304310443
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2019
Section Cited
HSC
1597.622
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 HSC:1597.622 Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year...
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Licensee will submit proof of immunizations to the department by proof of correction date of 07/15/19.
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This requirement was not met as evidence by Licensee and Licensees assistant did not have proof of immunizations, TDAP, MMR and Influenza during this visit. This poses a potential risk to the health and safety of the children in care.
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Type B
07/15/2019
Section Cited
HSC
1596.8662(2)(b)
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1596.8662(2)(b) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), ...
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Licensee will submit proof of mandated reporter training completion to the department by proof of correction date of 07/15/2019.

https://www.mandatedreporterca.com/
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This requirement was not met as evidence by: Assistant did not have proof of completion of mandated reporter training as required by title 22 regulations. This poses a potential risk to the health and safety of the chidren in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
Page: 4 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALCEDO, LORENA
FACILITY NUMBER: 304310443
VISIT DATE: 07/08/2019
NARRATIVE
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The children use the backyard and front yard for outdoor play time. Both of the yards are fenced and have appropriate toys for the children in care. There were no hazards observed in the outdoor areas during today’s inspection. There are no bodies of water located on the premises.

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the living room. Pediatric First Aid/CPR certificate are valid thru 07/28/20 for licensee. Licensee's disaster drill log notes last drill conducted on 04/08/19.

Licensee has a working telephone via cell phone. The licensee did have proof of the mandated reporter certificate training completed 03/11/2018. Immunization's required, MMR, TDAP and the Influenza shot were not verified. Licensees assistant file was also missing proof of immunization's and mandated reporter training as required by title 22. Licensee was advised that mandated reporter training expires every two years.

Detergents and cleaning supplies were inaccessible to the children in care. Fire extinguisher was inspected and met state regulations. There is an operational smoke detector and carbon monoxide in the living room. The licensee maintains a First Aid Kit in the home. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. Five children’s files were reviewed for LIC700 and Blue Immunization card. All files were complete. Licensee’s and Licensee’s assistant files were reviewed and were complete.



The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALCEDO, LORENA
FACILITY NUMBER: 304310443
VISIT DATE: 07/08/2019
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. Licensee states there are no children requiring medication. 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

Per Licensee there are two pets in the home. A cat and a dog of breed ( mini poodle) that are kept separate from the children in care.

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov, Licensee was advised where to access the quarterly updates and LPA Villa provided Licensee with the following email childcareadvocatesprogram@dss.ca.gov.


The following deficiencies will be cited on the 809D form.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 consecutive days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Licensee and Appeal rights were provided and explained. Licensee was informed that appeals must be submitted in writing within 15 days of a citation.

An exit interview was completed with licensee Lorena Salcedo.

Page 3 of 3 End of report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4