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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217154
Report Date: 10/01/2024
Date Signed: 10/01/2024 11:57:06 AM

Document Has Been Signed on 10/01/2024 11:57 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ERAZO SALGADO FAMILY CHILD CAREFACILITY NUMBER:
426217154
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/01/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:52 AM
MET WITH:Jackeline Erazo Salgado TIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On October 1, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced Prelicensing inspection at the abovementioned residence. LPA met with applicant Jackeline Erazo Salgado and informed them the purpose of the inspection. Applicant informed LPA the intention to provide care for children ages 0-13 years old. Applicant informed LPA the intention to have operating hours 5AM - 5PM, Monday to Friday and Saturday 5AM- 1PM. At the time of the inspection no children present.

LPA in the company of the applicant toured the interior and exterior of the home in its entirety. The residence is a single story home consisting of 3 bedrooms, 2 bathrooms, family room, living room, kitchen, garage and backyard. The home's family room, living room,1 bathroom and backyard will be used for child care purposes while the remainder of the home will be excluded from care.

LPA observed the interior of the home to have clean and have sufficient space for children in care. LPA observed family room to have age appropriate toys and equipment. LPA observed a file cabinet in the family room which has the ability to be secured. LPA advised applicant to ensure the filing cabinet is secure during day care hours. LPA observed the living room to be clean and orderly. LPA observed the door leading to the garage to be secured with a child proof lock. LPA advised applicant to ensure the garage door is always secured during daycare hours. LPA observed the kitchen to be made inaccessible to children via a child proof gate and that all cabinets and drawers to be secured with child proof locks. LPA advised applicant to ensure the child gate is in place to ensure the kitchen is inaccessible to children. LPA observed sharps to be stored in an elevated cabinet beyond the reach of children. LPA observed medication to be stored in a lock box that is located on an elevated shelf beyond the reach of children in care. LPA observed all the bedrooms to be made inaccessible to children via child proof locks. LPA informed applicant that all bedroom doors must be secured when children are present for them to be considered inaccessible. LPA observed the bathroom to be used for child care purposes to be clean and orderly. LPA observed the bathroom cabinets to be secured with child proof locks.
CONTINUED PAGE 2
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ERAZO SALGADO FAMILY CHILD CARE
FACILITY NUMBER: 426217154
VISIT DATE: 10/01/2024
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LPA observed the backyard to be completely enclosed. LPA observed the sides of the home and exit way to be secured with a mesh fence. LPA observed the yard to have sufficient space for children's activities. LPA observed a storage shed which is secured with a lock.

LPA observed a fire extinguisher that satisfies regulation (2A10BC) which was purchased on 8/8/2024. LPA reminded applicant that it is their responsibility to purchase or service a regulation fire extinguisher annually. The home has a smoke detector and a carbon monoxide detector which were tested at 10:28AM and found in working order. Applicant stated that there are no fire arms in the home.

LPA's record review revealed applicant's Preventative Health Training was completed on 7/12/2024. Further, applicant completed Mandated Reporter training on 7/26/2024 and Pediatric CPR/First Aid (EMSA approved) on 9/1/2024. Applicant completed FCCH orientation on 5/21/2024. LPA reminded applicant of obligation to maintain current training and certification.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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) or (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.
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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ERAZO SALGADO FAMILY CHILD CARE
FACILITY NUMBER: 426217154
VISIT DATE: 10/01/2024
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LPA reviewed with applicant 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. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and 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 applicant of 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.

On this date, 10/1/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Jackeline Erazo Salgado. This home meets Title 22 Division 12 requirements for a Small Family Child Care Home License. Effective date is noted as the present 10/1/2024.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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