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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409355
Report Date: 02/09/2023
Date Signed: 02/09/2023 04:11:11 PM

Document Has Been Signed on 02/09/2023 04:11 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SALAS, FABRIZIOFACILITY NUMBER:
073409355
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Fabrizio SalasTIME COMPLETED:
04:10 PM
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On 2/9/23 at 1:55 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an announced Pre-licensing Inspection at Fabrizio Salas home and met with Applicant, Fabrizio who has applied for a Small Family Child Care Home with a capacity of 8 children. The home was toured to conduct a Health and Safety Inspection. Present during today’s inspection is applicant. The Child Care home plans to operate Monday-Friday from 7am-5pm. Living in the home is applicant and applicant's brother.

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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

INDOOR SPACE: LPA toured the indoor space of the home. The home consists of living room, family room, kitchen, patio, 4 bedrooms, 2 bathrooms, backyard and garage.

IN-USE AREAS: Family room, patio, kitchen, hallway bathroom and backyard.

OFF-LIMIT AREAS: All bedrooms, master bathroom, living room and garage. LPA discussed with applicant there needs to be child proof doorknobs on all off-limit doors.

OUTDOOR SPACE: LPA toured the outdoor area (backyard). LPA observed there are no pools, hot tubs or other bodies of water. The backyard is fully fenced.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SALAS, FABRIZIO
FACILITY NUMBER: 073409355
VISIT DATE: 02/09/2023
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LPA observed: fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detector.The isolation area will be in family room. LPA discussed having medicines, cleaning products, sharp objects stored inaccessible to children in the kitchen and hallway bathroom. LPA reminded Applicant that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare home. Applicant states that there are no pets in the home. There are no arms or ammunition stored in the home. The home has a working telephone number.

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.

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)/ (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

Prior to licensure applicant shall provide proof of child proof door knobs on off-limit doors, child proof latches in kitchen, required postings and approval from management.



Exit interview conducted and report was reviewed with the applicant Fabrizio Salas.

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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SALAS, FABRIZIO
FACILITY NUMBER: 073409355
VISIT DATE: 02/09/2023
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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 platform.

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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
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