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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216263
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:05:04 PM

Document Has Been Signed on 04/22/2022 03:05 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SALGUERO FAMILY CHILD CAREFACILITY NUMBER:
406216263
ADMINISTRATOR:IRMA SALGUEROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 931-4366
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Irma SalgueroTIME COMPLETED:
03:05 PM
NARRATIVE
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On 4/22/2022, at 12:31 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management inspection and met with Licensee, Irma Salguero and minor assistant Brittney Ramirez LPA asked pre screening questions related to COVID -19, Licensee's responses indicate there are no COVID 19 exposure on site. LPA explained the purpose of the inspection, there were 11 children and 2 staff present during the inspection.

LPA Reyes and Licensee toured the home, LPA observed that garage and one room which were previously identified as off limits were being used by day care children. Licensee stated that she moved the day care area to the room near the garage and garage is used only for other extra activities of older day care children. LPA also observed that License, PUB 394 Family Child Care Home (FCCH) Notification of Parents' Rights and other licensing forms are not posted in the FCCH

LPA reminded Licensee that it was discussed during the pre licensing inspection that the Department should be notified of the proposed change.

During today's inspection deficiencies were cited under Title 22 Division 12 of California Code and Regulations.

The report was reviewed and translated in Spanish by Licensee's son Eric Salguero
Notice of Site Visit was issued and posted
Exit interview was conducted with licensee Irma Salguero.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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Document Has Been Signed on 04/22/2022 03:05 PM - It Cannot Be Edited


Created By: Gigi Reyes On 04/22/2022 at 02:11 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SALGUERO FAMILY CHILD CARE
FACILITY NUMBER: 406216263

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2022
Section Cited
CCR
102416.3(a)(6)

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a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, 6) Any change from an area of the family child care home previously identified as "off limits" ... This requirment is not met as evidenced by
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Licensee agreed to move back the day care area to the identified accessible area until the request for changes is granted. Licensee will submit the written proof of correction and the request no later than 5/2/2022.
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During the tour of the FCCH , LPA observed that room and garage previously identifed as off limits were being used by day care children.
This poses a potential risk to health and safety of children in care,
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Type B
05/02/2022
Section Cited
CCR102419(b)

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(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care.
This requirement is not met as evidenced by:
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During the inspection, Licensee posted all the required forms. Licensee will submit a written plan of correction no later than 5/2/2022 to ensure that the required Licensing forms will remain posted in the prominent area.
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During the inspection, LPA observed that Licence, PUB 394 FCCH Notifcation of Parents; Right and other required licensing forms were not posted in FCCH/day care home. This poses a potential risk to health and safety of 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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022


LIC809 (FAS) - (06/04)
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