Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814533
Report Date: 03/13/2019
Date Signed: 03/13/2019 04:03:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
364814533
ADMINISTRATOR:SALAZAR, UNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 373-6888
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:14CENSUS: 12DATE:
03/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee, Un SalazarTIME COMPLETED:
04:14 PM
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Licensing Program Analyst (LPA) Maddox met with licensee, Un Salazar today for te purpose of conducting an unannounced Annual/Random inspection. Licensee guided analyst on a tour of the home. There were 12 children present along with Licensee and Assistant, Saran Cho during this visit. Licensee's hours of operation are 4:45 am to 7:30 p.m. -8:00 a.m Monday thru Friday and some weekends. LPA did not observe any body's of water on the premises. There are family dogs on the premises. Licensee has since changed her telephone (725) 300-5844.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (swamp cooler, central air, and heating). This is a single story home which consists of 4 bedrooms, 2 bathrooms, kitchen, dining area, living room. There is a wood burning stove in the living room with wrought iron fencing surrounding it.

Per licensee, there are no weapons or firearms of any kind in the facility at this time. The required fire extinguisher (2A 10BC) and smoke/carbon monoxide detectors are in operable condition. Licensee has current CPR/First Aid valid (09/20/19). Licensee has the required Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394), Child Care Facility Roster (LIC9040), and Disaster Drill log posted and visible to parents.

The following were discussed: No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 364814533
VISIT DATE: 03/13/2019
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The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.

The following Incidental Medical Services (IMS) were discussed.
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

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records and Blue cards are all in the children's files. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.


No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was submitted to licensee. A copy of this report must be made available to the public for 3 years.

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov


https://ccld.childcarevideos.org/
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 364814533
VISIT DATE: 03/13/2019
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On or before March 30, 2018, 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 following the date on which he or she completed the initial mandated reporter training. mandatedreporterca.com

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2019
LIC809 (FAS) - (06/04)
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