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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844361
Report Date: 11/01/2019
Date Signed: 11/01/2019 10:01:02 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SALGADO FAMILY CHILD CAREFACILITY NUMBER:
364844361
ADMINISTRATOR:IRENE SALGADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 633-1898
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY:14CENSUS: 7DATE:
11/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Irene Salgado, LicenseeTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA), Carlos Martinez, made and unannounced Case Management visit on this date to deliver and amended LIC 809D. LPA met with Irene Salgado, Licensee, who was informed of the reason for the premise visit.


An exit interview was conducted, and a copy of this report was provided to the Licensee.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
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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