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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814533
Report Date: 08/07/2024
Date Signed: 08/12/2024 09:50:48 AM

Document Has Been Signed on 08/12/2024 09:50 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
364814533
ADMINISTRATOR/
DIRECTOR:		SALAZAR, UNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(725) 300-5844
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:14 PM
MET WITH:Licensee Un SalazarTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 8/7/2024, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by Licensee who permitted entry to the facility. LPA toured the facility with the Licensee according to the facility sketch. Upon arrival, LPA observed 8 children, with another one arriving later making it 9, and with 2 staff providing care and supervision.

During this inspection, LPA received pertinent documents related to this inspection which included the facility’s children’s rosters, personnel records, and other relevant documents. At 12:14pm, LPA Pittman was informed by the Licensee that Adult 1 was living in the home. Adult 1 is not fingerprint cleared and associated to the facility. The Licensee had Adult 1 leave the facility. This is a Type A Violation and civil penalties will be accessed.

As a result of the inspection, the facility was found to be in noncompliance with Title 22 Regulations and has been cited a Type A deficiency, see the LIC 809D for the details. As a Type A deficiency has been cited, a copy of the citation and licensing report must be posted for 30 days. The same report must be provided to Parents/Guardians and the Acknowledgment of Receipt of Licensing Reports LIC 9224 must be signed by Parents/Guardians of all enrolled children and any newly enrolled children in the next 12 months following the citation. If these requirements are not met, civil penalties per violation will be assessed.

All licensing reports are recommended to be kept for 3 years.

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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Document Has Been Signed on 08/12/2024 09:50 AM - It Cannot Be Edited


Created By: Andrea Pittman On 08/07/2024 at 02:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2024
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance(d)All individuals subject to a criminal record review...shall prior to working, residing... (1) Obtain a California clearance or a criminal record exemption...
This requirement was not met as evidenced by:
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Licensee had Adult 1 leave immediately and is aware that he cannot be present at the facility during operational hours until after Adult 1 has been fingerprint cleared and associated to the facility.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above by allowing Adult 1 to live in the facility for two months without a background clearance which poses an immediate 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.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


LIC809 (FAS) - (06/04)
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