406216263-3-1-2022-17-CC-GRES-CC4QGY-20220301111019

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406216263
Report Date: 03/01/2022
Date Signed: 03/01/2022 11:10:49 AM

Document Has Been Signed on 03/01/2022 11:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	SALGUERO FAMILY CHILD CARE		FACILITY NUMBER:	406216263
ADMINISTRATOR:	IRMA SALGUERO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 931-4366
CITY:	NIPOMO	STATE: CA	ZIP CODE:	93444
CAPACITY:	14	CENSUS: 1	DATE:	03/01/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Irma Salguero		TIME COMPLETED:	11:10 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	This is a change of location, previous License no. was 406210561 On March 1, 2022 @ 8:50 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection. Prior to inspection, LPA asked Applicant Pre- Screening questions related to COVID-19. Applicant’s responses to the Pre-screening questions suggest no COVID-19 exposure on site. LPA met with applicant Irma Salguero and adult son Eric Salguero and discussed the purpose of the Inspection. LPA conducted the physical plant tour of the home. During this tour the following was noted: Applicant applied for a Large Family Child Care. Family members residing in the home are 2 adults. All adults in the home are fingerprint cleared. Per Applicant, the operating hours will be Monday through Friday from 5 00 a.m. to 6:30 p.m. Applicant states she wants to care for children from 2 months old to 13 years of age. All areas identified on the facility sketch were inspected. This is a one story home with 3 bedrooms and 3 baths. Living room, kitchen, one bedroom dining, bathroom will be accessible to day care children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed the day care play area to be safe with age appropriate toys, games etc. The back yard is adequately fenced. LPA observed the covered and locked spa in the backyard keeping it inaccessible to day care children.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SALGUERO FAMILY CHILD CARE	FACILITY NUMBER: 406216263
	VISIT DATE: 03/01/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant, Irma Salguero

LPA reviewed with applicant, the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The home meets Title 22 Division 12 requirements of a Large FCCH, a 90 day provisional license is granted pending completion of Preventative Health, Safety and Nutrition Training. Effective date of license is today 3/1/2022.

Pre Licensing inspection and report was translated in Spanish by Adult son, Eric Salguero

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SALGUERO FAMILY CHILD CARE	FACILITY NUMBER: 406216263
	VISIT DATE: 03/01/2022

NARRATIVE

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The applicant states that she will provide food for children in care. There are age appropriate toys and napping equipment on the premises. Knives are stored out children’s reach, inaccessible to children Detergent and cleaning compounds are stored in the laundry area keeping them inaccessible to children.

The required fire extinguisher 2A10BC was serviced on 2/28/2022. Dual Smoke detector, carbon monoxide detectors were tested at 9:30 AM and were functioning at the time of the visit. Per Applicant, there are no guns nor ammunition in the home. First Aid and emergency kits are available.

The Applicant has current Pediatric First Aid and CPR which expires on 9/2/2023 Applicant is enrolled to Preventative Health Training. Applicant completed the Mandated Reporter Training on 10/13/2021. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with [applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC809 (FAS) - (06/04)

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