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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814533
Report Date: 01/17/2025
Date Signed: 01/17/2025 05:52:04 PM

Document Has Been Signed on 01/17/2025 05:52 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
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:
01/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Un SalazarTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
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This report is being amended to correct the deficiencies: On 1.17.25, Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced inspection at the facility. LPA was greeted by Licensee, Un Salazar, who granted LPA access and guided a tour of the facility. At the time of the visit LPA observed 9 children in care including 1 infant with the licensee and her assistant, Sarang Salazar.

During an inspection at the facility on 1.9.25 LPA observed 2 infants in pack n plays sleeping with blankets and bottles next to them. LPA asked the assistant to remove the blankets and bottles to which she complied. However, Safe Sleep regulations were discussed with licensee as indicated in licensing report dated 1.9.24 which was signed by the licensee. Furthermore, LPA observed safe sleep logs dated through 12.3.24 while infants were present in the facility on 1.9.25. LPA observed 3 children's files absent of current immunization records. Licensee stated she has asked the parent for the immunization records and they have not been provided to her. Although licensee reported an Unusual Incident regarding C1 wandering away from the facility on 1.7.25, Licensee failed to report that C2 also eloped on that date. Therefore, 3 Type A and 1 Type B citations were issued to the licensee for violation of CCR (Title 22, Division 12, Chapter 1, Article 6) (See LIC809D)

An LIC9224 - Acknowledgement of Licensing Reports shall be provided to the parent/guardian of any child currently enrolled in the facility by the next business day or immediately upon return as well as the parent/guardian of any child newly enrolled within the next 12 months. Failure to comply with this requirement will result in Civil Penalty.

This inspection was conducted in person. This report was read, and a copy provided to licensee, Un Salazar. Appeal Rights and Notice of Site visit was provided. Failure to post this report and Notice of Site Visit for 30 days could result in civil penalties. Exit interview conducted.

SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Claretta Yates
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/17/2025 05:52 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/17/2025 04:26 PM


Created By: Claretta Yates On 01/17/2025 at 12:36 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
PALMDALE CHILD CARE, 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: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/21/2025
Section Cited
CCR
102416.2(b)(2)

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102416.2 (b)(2) Reporting Requirements
The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) .Any child absence, child in care is missing, wanders away This requirement was not met as evidenced by
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 The department will seek Administrative Actions.
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Based on video and interviews conducted, licensee failed to report to the department that C2 got out of the backyard and was wandering around near the front of the facility which poses an immediate health, safety, and personal rights risk to children
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Type A
01/17/2025
Section Cited
CCR102425(j)(2)(D)

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102425(j)(2)(D) Infant Safe Sleep
The provider shall supervise infants while they are sleeping. The provider shall check and document the following: Documentation shall include the following: Date, Infant's name, Time of each 15-min check. This requirement was not met as evidenced
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 The department may seek Administrative Action.
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by: Based on record review the last entry of documented sleep checks for 2 infants in care was 12.3.24 which poses an immediate health, safety, and personal rights risk to children 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:Scott Herring
LICENSING EVALUATOR NAME:Claretta Yates
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/17/2025 05:52 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/17/2025 05:05 PM


Created By: Claretta Yates On 01/17/2025 at 01:11 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
PALMDALE CHILD CARE, 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: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/21/2025
Section Cited
CCR
102418(g)(1)

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102418(g)(1) Immunizations
The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
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The department will seek Administtative Actions.
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This requirement was not met as evidenced by: Based on record review 3 out of 3 children's files did not have current immunizations which poses a potential health, safety, and personal rights risk to children 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:Scott Herring
LICENSING EVALUATOR NAME:Claretta Yates
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2025


LIC809 (FAS) - (06/04)
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