198020079-6-3-2021-33-CC-TRAO-C3MUA9-20210603152421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020079
Report Date: 06/03/2021
Date Signed: 06/03/2021 03:24:40 PM

Document Has Been Signed on 06/03/2021 03:24 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	SALCEDO FAMILY CHILD CARE		FACILITY NUMBER:	198020079
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	06/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:58 AM
MET WITH:	Syvonney Salcedo, Licensee		TIME COMPLETED:	03:30 PM

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On 6/3/2021 at 11:58AM, Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Required - 1 Year on-site inspection and to provided technical assistance in regards to COVID-19. LPA stated the purpose of the visit with Licensee Syvonney Salcedo. This is a single-story home located at the corner of Ellen Drive and Cypress Street. There are 3 bedrooms & 1 bathroom. There are a total of 5 adults residing and no minor residing in the home. There is one child in care during the inspection.

At 1:30PM, Licensee guided LPA on a tour of the residence. All areas identified on the Facility Sketch were inspected to include the following:

Child care areas: Living room, dining area, kitchen, hall bathroom and fenced backyard.
Off limit areas: 3 Bedrooms, front yard, garage and pool.

All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensees state that there are no poisons in the home. The licensees understand that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in all areas in the home.

Per licensee, there are no weapons, firearms or bodies of water on the premises. LPA observed the swimming pool is secured. There are 4 dogs on premises. Per Licensee, all 4 dogs were vaccinated. There were toys observed for children. Posting requirements were observed to be posted at the time of inspection. Children’s record was reviewed.

The valve on the required 2A 10BC fire extinguisher indicates it was fully charged. Smoke and carbon monoxide detector in day care room were tested, and were operable.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SALCEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020079
	VISIT DATE: 06/03/2021

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The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. All adults present have obtained a criminal record clearance. The licensees and her assistants have proof of current pediatric first aid and CPR (expires: 08/24/2022). Licensee has completed required mandated reporter training, certificates on file.

The following was discussed:

INFANT CARE: Licensees state that they do care for infants. LPA discussed the licensees' plan for supervising sleeping infants.
Licensees state the following: Any infants in care will stay in the day care room where the licensees or assistant are.
LPAs advised the licensees to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The licensees state that they will not sleep infants in a separate room. LPAs reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.

Medication: 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

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

Per licensee, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on file. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SALCEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020079
	VISIT DATE: 06/03/2021

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LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov
LPA helped Licensee to download the CDSS apps on her phone.

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s files that were reviewed during this inspection.

LPA provided copies during this inspection:

Child Care Program (CCP) COVID-19 Self-Assessment blank form
PIN 21-08-CCLD Oversight Role and Resumption of On-site Inspections

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SALCEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020079
	VISIT DATE: 06/03/2021

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Title 22, Division 12 Chapter 1 Article 04. Enforcement Provisions 102391 Inspection Authority of the Department
LIC 279 Application for a Family Child Care Home License blank form
LIC 9040 Child Care Facility Roster blank form
PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect
LIC 9227 Individual Infant Sleeping Plan
PIN 19-02-CCP Safe Sleep Awareness Campaign

LPA obtained the following during this inspection:

Updated LIC 279 to indicate the new phone, one additional adult and the ages to be served
Updated LIC 9040
Completed CCP COVID-19 Self-Assessment.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

There are no citations being issued at the time of inspection under California Code of Regulations, Title 22 Division 12.

Exit interview was conducted with Licensee. Appeal rights explained & provided together with the Facility Evaluation Report.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC809 (FAS) - (06/04)

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