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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019752
Report Date: 08/18/2021
Date Signed: 08/18/2021 11:16:43 AM

Document Has Been Signed on 08/18/2021 11:16 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
198019752
ADMINISTRATOR:SELENA MARIE SALAZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 430-6377
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Selena Salazar, LicenseeTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Thelma Razo conducted a Case Management - Other visit to deliver an amended report of the Required - 1 Year inspection done on 8/11/2021 to add citation CCR 102425(c) - absence of Individual Sleeping Plan (LIC9227) for Child #2. LPA met with Licensee Selena Salazar and stated the purpose of the visit.

Licensee was advised to review the recent Los Angeles County Department of Public Health dated 8/2/2021 - Guidance Early Care and Education. Accordingly, it is required for child day care to wear mask indoor except for children under two years old at this time. LPA also advised Licensee to review the said publication regarding COVID-19 screening prior to facility entry and to implement precautionary measures to mitigate the spread of COVID-19. Licensee was provided with COVID-19 Self-Assessment for Child Care Program and was submitted to LPA during this inspection.

Exit interview conducted, notice of site visit issued and posted and must remain for 30 days. Failure to comply will result in an immediate civil penalty in the amount of $100. A copy of Appeal Rights and LIC 809 is provided.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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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