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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364814533
Report Date: 10/23/2024
Date Signed: 10/23/2024 10:51:13 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2024 and conducted by Evaluator Andrea Pittman
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240805112357
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
364814533
ADMINISTRATOR:SALAZAR, UNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(725) 300-5844
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:14CENSUS: 9DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Licensee Un SalazarTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Allegation 3: Licensee does not live in the family child care home
INVESTIGATION FINDINGS:
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On 10/23/2024, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced complaint visit to deliver the findings at the facility and was met by the Facility Representative who permitted entry to the facility. LPA toured the facility with the Licensee according to the facility sketch. Upon arrival, LPA observed 9 children with 2 staff members providing care and supervision.

During this investigation, LPA received pertinent documents related to this investigation, which included the facility’s staff and children’s rosters and other relevant investigation documents. The investigation revealed the following information:

Continue to next page
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2024 and conducted by Evaluator Andrea Pittman
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240805112357

FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
364814533
ADMINISTRATOR:SALAZAR, UNFACILITY TYPE:
810
ADDRESS:313 MUIR AVENUETELEPHONE:
(725) 300-5844
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:14CENSUS: 9DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Licensee Un SalazarTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegation 1: Licensee did not ensure adequate care and supervision was provided to children
Allegation 2: Licensee did not obtain permission from child's authorized representative to administer medication to the child
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/23/2024, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced complaint visit to deliver the findings at the facility and was met by the Facility Representative who permitted entry to the facility. LPA toured the facility with the Licensee according to the facility sketch. Upon arrival, LPA observed 9 children with 2 staff members providing care and supervision.

During this investigation, LPA received pertinent documents related to this investigation, which included the facility’s staff and children’s rosters and other relevant investigation documents. The investigation revealed the following information:

Continue to next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 12-CC-20240805112357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 364814533
VISIT DATE: 10/23/2024
NARRATIVE
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Allegation 1: the first allegation stated that the Licensee did not ensure adequate care and supervision was provided to children. After conducting interviews, record reviews, and observations, the LPA received information that adequate care and supervision was being provided during operational hours. There is an assistant on site to help over the capacity and the assistant has been present in the facility during the operational hours. After reviewing all the relevant information obtained, there is not a preponderance of the evidence to support the allegation.

Allegation 2: the second allegation stated that the Licensee did not obtain permission from child's authorized representative to administer medication to the child. During the investigation, LPA conducted interviews, record review, and observations of relevant complaint documents. There was no supporting evidence that the facility administered medication to a child in care without the authorized representative's permission. After reviewing the relevant information obtained, there is not a preponderance of the evidence to support the allegation.

After observations, record reviews, and interviews, it was determined that there was insufficient evidence that the Licensee did not ensure adequate care and supervision and that they did not obtain permission to administer medication to children in care. The allegations could not be corroborated with the evidence found during the investigation. Therefore, the allegations have been found unsubstantiated. Although, the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the facility operated in violation of policy in this circumstance.

An exit interview was conducted, and a copy of this report was provided to the Facility Representative along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 12-CC-20240805112357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 364814533
VISIT DATE: 10/23/2024
NARRATIVE
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Allegation 3: The third allegation states that the Licensee does not live in the family child care home. During the observation, interviews, and record review, the following was revealed: the Licensee has a second home not far from the family child care facility. The Licensee would live in the second home and come to the child care facility during operational hours and return to the second home to live after the child care hours. This is a Type B citation, see the LIC 9099D for the details.

Based on information obtained, observations, and interviews with relevant complaint parties, the allegation is deemed substantiated for allegation 1; as a result, one Type B citation will be issued for the allegation. A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met. As a result of the investigation, the facility was found to be in noncompliance with Title 22 Regulations and has been cited a deficiency, see the LIC 9099D for the details.

An exit interview was conducted, and a copy of this report was provided to the Facility Representative along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 12-CC-20240805112357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 364814533
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2024
Section Cited
CCR
102352(h)(1)(a)
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102352 Definitions
(h) (1) "Home" means the licensee's residence…In determining the place of residence the following rules shall be observed:.. (a) It is the place where one remains…

This requirement was not met as evidenced by:
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Licensee will attend an informal conference meeting in office no later than 11/06/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above by not living in the residence of the family child care home which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5