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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376602479
Report Date: 09/28/2021
Date Signed: 09/28/2021 11:42:05 AM

Document Has Been Signed on 09/28/2021 11:42 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SALVADOR, ARIEL & ANITA FAMILY CHILD CAREFACILITY NUMBER:
376602479
ADMINISTRATOR:ARIEL & ANITA S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 467-9821
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Anita SalvadorTIME COMPLETED:
11:50 AM
NARRATIVE
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On September 28, 2021 at 8:40 a.m. Licensing Program Analyst (LPA), Leilani Curtis visited the facility to conduct an unannounced Annual Inspection. Upon arrival LPA met with Licensee, Anita Salvador. Also present was the co-licensee Ariel Salvador and helper Melonie Giambra. The licensee’s adult son, Allan Salvador was also present in an off limits bedroom. There were 10 children in care, 3 of them infants. Facility was observed operating within ratio and capacity. LPA conducted a tour of the home inside and outside per facility sketch. Licensee is using the following areas for daycare: play area #1, play area #2 (formally the family room and covered patio), sick room, hallway bathroom and enclosed rear yard. The children also have access to the living room, dining room and kitchen. Off-limits areas include: all bedrooms and the second floor of the home. The licensee states that they added a wall in play area #2 to create a separate isolation area for sick children in April 2020.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. Stairs are barricaded. There is a working telephone/email address. All cleaning compounds, detergents, medications, and poisons are made inaccessible through latches, locks, and/or placed up on high surfaces. The fireplace is screened. The fire extinguisher and smoke and carbon monoxide detectors are operational. Licensee states there are NO firearms or other weapons in the home. Outdoor play area is fenced and free of hazardous items. There are no existing bodies of water present. Children records were reviewed for Emergency Information. Four of Ten children’s files reviewed were missing immunization records. The last documented disaster/fire drill was conducted on 3/5/21. There are no new adults living or working in the home over the age of 18 years. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Pediatric CPR and First-Aid certificates for Anita Salvador are valid through 3/31/23. The CPR/First Aid certificate for co-licensee Ariel Salvador expired in 01/2021. Mandated Reporter certifications were reviewed for the co-licensees and their helper. All three certifications expired in 7/2021. Immunization records per SB792 were reviewed and are in compliance.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SALVADOR, ARIEL & ANITA FAMILY CHILD CARE
FACILITY NUMBER: 376602479
VISIT DATE: 09/28/2021
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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.

LPA reviewed the following with Licensee: Recently Approved Safe Sleep Regulations PIN 20-24-CCP, Updated Coronavirus Industry Guidance PIN 21-18-CCP, California Dept. of Public Health Guidance for Child Care Providers dated 6/29/21, Car Seat Law, clearances, emergency drills, mandated reporting, SIDS, and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee is aware that interference with a child’s daily functions, corporal punishment, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

Please see LIC809D for cited deficiencies

The LPA reviewed this report with licensee and provided a copy of her appeal rights (LIC 9058 01/16). Her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.
Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/28/2021 11:42 AM - It Cannot Be Edited


Created By: Grace Curtis On 09/28/2021 at 10:37 AM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SALVADOR, ARIEL & ANITA FAMILY CHILD CARE
FACILITY NUMBER: 376602479

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2021
Section Cited
CCR
102416(c)

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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced by:
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The licensee states that her co-licensee Ariel Salvador will submit a current CPR/First Aide certificate to LPA via email by POC due date.
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Based on LPA's record review, licensee Ariel Salvador's CPR/First Aide certificate expired in 01/2021. This poses a potential health and safety risk to children in care.
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Type B
10/12/2021
Section Cited
HSC1596.8662(b)(1)

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A person who, on January 1, 2018, is a licensed child 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...This requirement was not met as evidenced by:
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The licensee states that she, her co-licensee Ariel Salvador & helper Melonie Giambra will submit a current Mandated Reporter certificate to LPA via email by POC due date.
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Based on LPA's record review the Mandated Reporter certifications for licensee Anita Salvador, licensee Ariel Salvador & helper Melonie Giambra expired in 7/2021. This poses a potential health and safety risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2021 11:42 AM - It Cannot Be Edited


Created By: Grace Curtis On 09/28/2021 at 10:48 AM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SALVADOR, ARIEL & ANITA FAMILY CHILD CARE
FACILITY NUMBER: 376602479

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2021
Section Cited
CCR
102418(g)

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Immunizations: The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement was not met as evidenced by:
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The licensee states that she will submit copies of immunization records for the four children whose files were missing the documentation to LPA via email by POC due date.
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Based on LPA's record review four of ten children file's reviewed were missing immunization records. This poses a potential health and safety risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021


LIC809 (FAS) - (06/04)
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