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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313603
Report Date: 06/16/2021
Date Signed: 06/16/2021 02:42:57 PM

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:SALAZAR, VICTORIAFACILITY NUMBER:
304313603
ADMINISTRATOR:SALAZAR, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 487-3020
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:14CENSUS: 13DATE:
06/16/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Victoria SalazarTIME COMPLETED:
03:20 PM
NARRATIVE
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A Plan of Correction (POC) inspection was conducted at the facility by Licensing Program Analyst (LPA) Valencia. LPA observed licensee caring for 13 children, with an adult assistant. Licensee was observed to not be operating within compliance of ratio. Of the 13 children in care none were attending and enrolled in Kindergarten or older.

The purpose of today's inspection was to verify two A violations cited on 6/11/21 had been corrected. On 6/11/21 during a 1 year inspection, the facility was cited an A violation for operating over the licensed capacity by having 15 children in care. From the LIC811 from 6/11, child #7 and child #15 were the 2 children not in attendance during today's POC inspection. And was also cited another A violation for not having any children enrolled in and attending kindergarten or older, of those 15 children in care. During today's inspection it was observed that the licensee was operating within the capacity limit of her license by having 13 children in care, but did not have a child enrolled in and attending kindergarten. This is in violation of Title 22 Regulation 102416.5(d)(2)(a), and an immediate threat to the children's health and safety. This is a repeat A violation and the licensee is assessed a civil penalty. Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. An exit interview was conducted with licensee. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door/facility entrance.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SALAZAR, VICTORIA
FACILITY NUMBER: 304313603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2021
Section Cited

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At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
This was not met as evidenced by:
Of the 13 children in care during today's POC inspection the licensee did not have a child enrolled in and attending
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kindergarten. This is an immediate threat to the children's health and safety.
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* a civil penalty was assessed*

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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: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2021
LIC809 (FAS) - (06/04)
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