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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313603
Report Date: 06/22/2021
Date Signed: 06/22/2021 01:20:42 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: 9DATE:
06/22/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Victoria SalazarTIME COMPLETED:
01:45 PM
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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 9 children, with an adult assistant. The facility was observed to be operating within compliance of ratio and compliance of capacity.

The purpose of today's inspection was to verify two A violations cited on 6/11/21, and one violation cited on 6/16/21 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, and on 6/16/21 a plan of correction inspection was conducted to check that the 2 A violations cited on 6/11/21 were corrected and observed was that 123 children were in care and there was not a child enrolled in and attending kindergarten or older in care. A plan for returning to compliance of ratio and capacity regulations was emailed to LPA, and today LPA observed that this plan licensee email to LPA was completed. Observed were 9 children, and the facility in compliance. The licensee was left the plan of correction letters for the 2 A violations cited on 6/11 and the 1 A violation cited on 6/16, for their records.

In the areas that were evaluated, NO deficiencies were observed of the California Code of Regulations, Title 22, Division 12 during today’s inspection.

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.
End of Report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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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