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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444412936
Report Date: 12/21/2022
Date Signed: 12/21/2022 01:32:05 PM


Document Has Been Signed on 12/21/2022 01:32 PM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:SALCEDO, HILDAFACILITY NUMBER:
444412936
ADMINISTRATOR:SALCEDO, HILDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 763-3920
CITY:FREEDOMSTATE: CAZIP CODE:
95019
CAPACITY:14CENSUS: 5DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Hilda SalcedoTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Hilda Salcedo, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Saturday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, and her spouse Gustavo, and her three tenants Kevin, Lucia, and Edith. Licensee's minor child age 16 also resides in the home. LPA observed five children were present during today's inspection, included one infant and four preschool age. Licensee's helper Angelica was also present during the inspection. Certification for CPR and First Aid Card for Licensee are current and will expire on 9/16/23 and 3/20/24 respectively. .

LPA toured the indoor and outdoor areas of the two story home during today's inspection. LPA observed the day care is located in a separate section of the home with independent entrance and bathroom. LPA obtained a copy of the children's roster today and it is current. LPA reviewed five children files and observed files are complete. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 12/15/22
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: All the second floor with independent entrance where the tenants live, and the main home with off limits areas: 3 bedrooms, 1 bathroom, kitchen, gym, and laundry room. Off limits areas outside: All the right side yard. The home has back yard and it is fenced, Licensee uses the back yard as playground.
LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 2/07/22 and at least one working combo smoke/carbon monoxide detector. LPA observed there are not stairs inside the home. LPA observed the day care area has a barricaded wall heater, and there are not bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

*******************Report dated 12/21/22 continues on page 2
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SALCEDO, HILDA
FACILITY NUMBER: 444412936
VISIT DATE: 12/21/2022
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Report dated 12/21/22 continues from page 1.

According with the SB792, Licensee has in file proof of immunization for pertussis, measles, and influenza for herself and for her helpers Angelica and Valeria.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and ratio must be observed. Licensee understands children residing in the home under 10 years old count as part of the capacity of her license. The Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.

Department website: www.ccld.ca.gov provided to Licensee. Licensee has renewed the "Mandated Reporter" training on 3/24/21 and her helpers Angelica and Valeria on 4/27/22 and 3/31/21 respectively. Licensee was advised that all adults in contact with children are required to complete the "mandated reporter" training. LPA referred the Licensee to the Department website: www.mandatedreporterca.com for additional information on the online training.

A review of staff records on 12/20/22 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Hilda was reminded that all adults 18 and over living or working in the home, 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.

Report dated 12/21/22 continues on page 3.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SALCEDO, HILDA
FACILITY NUMBER: 444412936
VISIT DATE: 12/21/2022
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Report dated 12/21/22 continues from page 2.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.


Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee Hilda was requested to submit updated forms LIC279, and LIC279B both provided.

Exit interview conducted and report was reviewed with the licensee Hilda Salcedo.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3