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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417464
Report Date: 06/24/2022
Date Signed: 06/24/2022 01:50:29 PM

Document Has Been Signed on 06/24/2022 01:50 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
197417464
ADMINISTRATOR:MARIA SALAZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 689-9881
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Selena RodriguezTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Doris Whitmore conducted a site visit for the purpose of an Annual Random visit. LPA met with the Teacher Selena Rodriguez, who guided analyst on a tour of the facility. The facility is operating Monday thru Friday from 8:30a.m. am until 4:30 pm. LPA also spoke with the Licensee over the phone which was Maria Salazar.

There were 4 infants and 6 preschoolers in care. LPA observed three Teachers working with children at the time of inspection. LPA Whitmore verified that all adults present in the home has fingerprint clearance and are associated to the facility.

. This is a 2 bedroom, 1-bathroom duplex unit home. The following areas are designated as off limits in the Family Child Care Home: bedrooms 1 and 2, kitchen area, and laundry area. Main care is provided in the living room. Children in care have access to the bathroom. Licensee also utilizes the backyard area which has been transformed into an outdoor/indoor classroom and play area.

LPA observed a working smoke detector, carbon monoxide detector, fully charged 2A10BC fire extinguisher and a working telephone. There was good lighting and ventilation at the facility as well. All electrical outlets were covered with plastic covers. All detergents, cleaning supplies are stored in well latched cabinets. Sharp objects, including knives are stored in well latched cabinets in the kitchen. Medications are stored away from children’s reach. Per the licensee, there are no firearms on the premises. LPA observed a first aid kit, age appropriate toys and mats for napping. LPA shared about the documentation of the Sleep Log and Sleep Plan. LPA also discussed with the Licensee about documenting Fire Drills and a form was given for the facility to use.LPA observed that one teacher has current CPR, first aid which expires 12/29/2023. There are no bodies of water at the facility. LPA observed that all necessary postings (i.e. Notification of Parents’ rights, Emergency Disaster Plan, Facility License, etc) were posted on a board outside where parents pick up and drop off their children.Page 1
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 197417464
VISIT DATE: 06/24/2022
NARRATIVE
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LPA observed a total of 10 children files some of the files were missing immunization records on blue cards and immunization records. LPA observed a total of three files for the staff. Staff were missing Mandated Reporter Training and Preventative Health & Safety and Immunization Records. LPA spoke to the Licensee over the phone and documentation would need to be submitted by 06/29/22

LPA discussed with licensee that walkers, exersaucers/walkers without wheels, jumpers & bouncers are not allowed in day care facilities. LPA discussed capacity limitations, new car seat law, personal rights, Notification of Parent's Rights revised 12/06, inspection authority & agency's consultative role. Smoking is prohibited on the premises when children are present. The LPA also discussed earthquake safety and necessity of drills every 6 months. The applicant was also informed that all adults living in or having access to day care children in the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $100 /day per uncleared adult will be assessed.

The following were also discussed with licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint. Page 2

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 197417464
VISIT DATE: 06/24/2022
NARRATIVE
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Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Please see Child Care Quarterly Report on www.ccld.ca.gov.

LPA shared with the Licensee over the phone the information for the Mandated Reporter Training and the website for the Mandated Reporter www.mandatedreporter.com. LPA shared with the licensee that the staff would need to register.

Per Title 22 Division 12, Chapter 3 of the California Code of Regulations, the following deficiency is being cited (see next page,809D) Licensee was provided a copy of appeal rights.

Exit interview was conducted and a copy of the report was provided to the Teacher Selena Rodriguez Page 3

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2022 01:50 PM - It Cannot Be Edited


Created By: Doris Whitmore On 06/24/2022 at 01:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 197417464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [3t] out of [3] (persons)] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2022
Plan of Correction
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The Licensee will register the teaching staff and once completed will email a copy and place in file.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [3] out of [total 3 (persons) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2022
Plan of Correction
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Update Teachers immunization record make acopy and send documentation.
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Doris Whitmore
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 06/24/2022 01:50 PM - It Cannot Be Edited


Created By: Doris Whitmore On 06/24/2022 at 01:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 197417464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [3] out of [total 3] [(objects) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2022
Plan of Correction
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Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [3] out of [total 3 [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2022
Plan of Correction
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Teachers will get immunization cards and place in folder
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Doris Whitmore
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022


LIC809 (FAS) - (06/04)
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