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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844361
Report Date: 10/18/2019
Date Signed: 10/21/2019 10:59:26 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:
10/18/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Irene Salgado, LicenseeTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Carlos Martinez, conducted a Case Management visit this date to deliver deficiencies observed during an IB investigation conducted by Investigations Branch (IB) Investigator, Charlotte Jackson. On or about September 5, 2019, Investigator Jackson noted that Staff #1 was employed at the facility since August 2019, and did not have a fingerprint clearance and/or exemption as required.


See LIC809D for cited deficiencies.
Appeal rights were discussed and a copy of this report was provided to the licensee on this date.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SALGADO FAMILY CHILD CARE
FACILITY NUMBER: 364844361
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2019
Section Cited

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CRIMINAL RECORD CLEARANCE:

All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a Caifornia clearance or a criminal record exemption
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as required by the Department. This requirement was not met as evidenced by; The Licensee confirmed that Staff #1 has been employed at the day care since August, 2019 and has not obtained a fingerprint clearance and/or exemption.
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clearance.

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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2019
LIC809 (FAS) - (06/04)
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