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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314099
Report Date: 11/10/2022
Date Signed: 11/11/2022 08:48:08 AM

Document Has Been Signed on 11/11/2022 08:48 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SALAZAR, SUSANFACILITY NUMBER:
304314099
ADMINISTRATOR:SALAZAR, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 396-3161
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:ApplicantTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced in-person Pre-Licensing inspection for the purpose of re-locating from license # 304313817 for a new Large Family Child Care home. LPA met with Applicant, Susan Salazar who provided a tour of the new home.

A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared.
Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office.

Applicant is requesting for a Large Family Childcare Home license. Operation hours will be Monday to Friday 5:00 AM to 6:00 PM and care and supervision will be provided to children ages from birth to 13 years old.
All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single one story home with 3 bedrooms, 2 full bathrooms, Living room, dinning room area, kitchen, garage, and back yard.
Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation and heating. Telephone service (cell phone is the primary contact phone) .

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children stored in the locked garage and top cabinets. The Licensee states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALAZAR, SUSAN
FACILITY NUMBER: 304314099
VISIT DATE: 11/10/2022
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Based on the Facility Sketch submitted, areas off limits to children are: .

Parents and children will enter the home, through the main entrance door, leading to day care area. The applicant has designated dinning area for day care children. There is one full bathroom designated for children usage. The living room is barricaded by a baby gate from the dining area and kitchen is barricaded from the children's area (dinning area)

The designated day care area is one room which is for eating, playing, napping & reading, and day care activities. This room was observed to have age appropriate activities and educational items for enrolled children. There are two pack and play for the use of children under 2 years of age. Beddings are provided by provider. Applicant shall provide ongoing supervision during nap time. Every 15 minutes check on children under 2 years old and documenting on the log was discussed with applicant, Susan Salazar.

There are 3 bedrooms which are equipped with child proof door knobs on them. There is a child safety gate installed at the beginning of the kitchen entrance making the kitchen inaccessible to children. There is a baby gate installed in front of the dinning area making the family room inaccessible to children.

Garage is detached and has accessibility from the back yard. The garage is in off limit area and is inaccessible to children and opens with electronic device.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

Licensee will use the cell phone for day care and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation.



Licensee was informed and understands the home is to be free from smoking during hours of operation.
Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

The applicant has provided the proof of control of property to LPA..

The children's bathroom is located next to the bedrooms in the hallway behind the baby gate for children's

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALAZAR, SUSAN
FACILITY NUMBER: 304314099
VISIT DATE: 11/10/2022
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use. There are cabinets under the sink. The children's bathroom was observed to be safe and free of hazardous items.

Applicant provides AM/PM snacks and lunch to children. If food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Upon entrance through the designated main door of the home, applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines,

OUTDOOR PLAY AREA: Applicant will use the patio adjacent to the back yard area for children's outdoor activities. The back yard is all fenced. The patio has age appropriate activity items for children in care. It is safe for outdoor activities. The outdoor space for children's activity is away from the back yard where the fenced swimming pool is located.

There is a swimming pool located in the back yard which is off limit for children. The swimming pool is all mesh fenced with at least 5 feet height. There is a self latched gate which opens against the pool. When it was tested the gate was not operating well enough to be self latched.

The sliding door in the dinning area (Children's area) leading to the back yard has a screen door. Both screen door and sliding door are equipped with a lock on them. The applicant will equip this sliding door with an alarm device.

There is no pets, and firearms, weapons in the home.

The fire extinguisher met the licensing requirements. The applicant has the right size of 2A10 BC fire extinguisher. Smoke and carbon monoxide detectors were tested and are operable. LPA observed the fire extinguisher was mounted on the wall behind kitchen area. Smoke detector/ Carbon Monoxide are mounted on the wall. They were tested and working.


Applicant has not completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 7/19/2024. There are first aid supplies available.
The following was discussed with the applicant: In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric 1st Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility. Continued on page 4
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALAZAR, SUSAN
FACILITY NUMBER: 304314099
VISIT DATE: 11/10/2022
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Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated. The fire extinguisher type 2A-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No Johnny jumpers, No Baby walkers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian



LPA discussed the following items with the Applicant, Susan Salazar during the Exit interview:

Criminal Record statement: Applicant, Susan Salazar 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.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALAZAR, SUSAN
FACILITY NUMBER: 304314099
VISIT DATE: 11/10/2022
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Fire clearance has been approved for 14 children.

Safe Sleep : LPA discussed the safe sleep regulations with applicant, Susan Salazar & 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 of the applicant, Susan Salazar 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 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.

Review of records to be maintained : LPA reviewed with Applicant, Susan Salazar, and her spouse 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. (LPA gave the LIC 311D with all the required forms and Fire logs to be maintained in the home). A packet of enrollment for children and posting forms were printed out and were given to applicant. A sample of very 15 minutes check log was given to applicant.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SALAZAR, SUSAN
FACILITY NUMBER: 304314099
VISIT DATE: 11/10/2022
NARRATIVE
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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.


OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment. The facility at the time of Pre-licensing inspection is not in compliance for a (Small Family Child Care Home) with Title 22 Regulations



At the time of inspection, the applicant was not in compliance with Title 22 Regulations.
A license for a Large family childcare home will be issued after correcting the below and final review and management approval.
1- Repair of the gate of the swimming pool so it works self latched properly.
2- Installation of an alarm device on the sliding door leading to back yard and patio.
3- Wooden tall shelf in the children's area shall be secured to the wall.
4- TB clearance for one adult resident.
5- Mandated Reporter Training Certificate. You can obtain it at www.mandatedreporterca.com


Exit interview was held with applicant, Susan Salazar and appeal rights were presented.

End of report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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