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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019752
Report Date: 08/18/2021
Date Signed: 08/18/2021 11:40:42 AM

Document Has Been Signed on 08/18/2021 11:40 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
198019752
ADMINISTRATOR:SELENA MARIE SALAZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 430-6377
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/18/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Selena Salazar, LicenseeTIME COMPLETED:
11:45 AM
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An unannounced Plan of Correction inspection was conducted by Licensing Program Analyst (LPA) Thelma Razo to ensure that the deficiencies issued on 8/11/2021 during Required - 1 Year inspection was corrected including the amended citation. LPA met with Licensee Selena Salazar and stated the purpose of the visit.

Citations were as follows:
  • HSC 1596.8662(4)(b)(1) - Mandated Reporter Training is required to be renewed every two years, however, Licensee and assistant Esperanza Vasquez had expired on 5/19/2020.
  • 102417 (g)(1) - fire extinguisher has not been serviced as evidenced by the absence of service tag.
  • 102425(j)(D) - absence of sleep log for two infants.
  • 102417(b) - presence of animal feces in the backyard.
  • 102425(c) - absence of Individual Sleeping Plan (LIC9227) for Child #2 (C2).

Today, LPA obtained proof of compliance for the above citations.
  • Mandated Reporter was renewed by Licensee on 8/16/2021 and Espe Vasquez aka Esperanza on 8/12/2021.
  • LPA observed fire extinguisher has service tag dated August 10, 2021.
  • A statement indicating that individual sleep log will be kept on all infants to include the name, date, time of each 15-minute check along with initials.
  • LPA observed there were no more animal feces in the backyard.
  • LIC9227 for C2 was provided. Licensee also provided a statement that all infants under 12 months will have an individual sleeping plan in their file.

The Notice of Site Visit (LIC 9213) was posted by LPA – must remain for 30 days after each site visit by a licensing representative. Failure to maintain posting as required will result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 198019752
VISIT DATE: 08/18/2021
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An exit interview was held with Licensee, copy of this report and Letter of Deficiency Citations Cleared were provided.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
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