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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700527
Report Date: 01/08/2026
Date Signed: 01/08/2026 02:02:02 PM

Document Has Been Signed on 01/08/2026 02:02 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
367700527
ADMINISTRATOR/
DIRECTOR:		UN SALAZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(725) 300-5844
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/08/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:04 AM
MET WITH:UN SALAZAR, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On January 8, 2026, at 10:50am Licensing Program Analyst (LPA), Ali met with Applicant for the purpose of conducting a Pre-Licensing Inspection. Applicant is requesting to provide care and supervision for a Large Family Child Care Home for the capacity of 14 children. Present during the pre-licensing inspection is applicant and applicant adult child. Currently residing in the home is applicant and applicant adult child. All adults (2) residing in the home have a Criminal Record Clearance DOJ/FBI and Child Abuse Index Clearance. LPA toured the home indoors and outdoors to ensure the home meets licensing requirements. Applicant is requesting the days and hours of operation will be: 5:00am to 6:00pm, Monday through Friday. Per applicant, there is no overnight care to be provided. Applicant states she will provide transportation. Applicant states she has an assistant that she will use once she reaches census over 8 children. Applicant states assistant will meet all requirements from LIC 126 form including criminal record clearance through guardian.

Physical Plant: This is a single-story home with four bedrooms, three bathrooms, a kitchen, dining area, living room #1 (daycare area), living room #2, daycare office, laundry room, front yard, backyard, and garage. The home is inspected for safety, comfort, cleanliness, telephone service, and proper ventilation. The home has security alarm system and cameras in common areas.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 367700527
VISIT DATE: 01/08/2026
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 Applicant will utilize her cell phone for daycare business. The home has central air conditioning and heating with the unit located in the backyard off-limits (by metal gate). All windows have screens, and free of bugs, and debris. There are blind cords in the entire home inaccessible to children. There is a fireplace in the living room #2 inaccessible to children. LPA observed in daycare areas (living room #1, bathroom #1, daycare office, and backyard) a large TV mounted to the wall in living room #1, books, toys, cubbies for children belongings, couches, three tables, diaper changing station, play pen were observed. Kitchen was inspected for hazardous or dangerous items. LPA observed all bottom kitchen drawers and cabinets at lower levels to have safety latches and locks. LPA observed one trash can with tight fitted lid and water filter station. Over the counter medication and first aid kit are stored in left top cabinet in kitchen inaccessible to children. Chemicals are located in the kitchen under the sink and in the cabinets in laundry inaccessible to children by safety latches. The knives and sharp items are stored in the top left drawer next to kitchen sink inaccessible to children (safety latched). LPA observed safety gate present in box. Applicant stated she will have safety gate installed prior to children being enrolled. Applicant will have her family friend install the safety gate since it needs to be screwed into the wall. The refrigerator and both freezer are both operable. LPA observed all bedrooms to be locked. Daycare Area: LPA observed age-appropriate furniture, toys, and books for children. For napping, applicant states that the living room #1 will be used for napping. LPA did observe napping materials and car seat stored in daycare office closet. The isolation area will be in daycare office where child can rest until parent can pick up the child.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 367700527
VISIT DATE: 01/08/2026
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Daycare Bathroom: The bathroom is the first door to the left through the daycare office. Bathroom was toured and inspected it has one sink, one toilet, and one tub/shower that are operable. The bathroom was clean, sanitized, and in good repair. There are cabinets in the bathroom against the wall, all have locks on cabinets.

Outside: The front yard is off limits. Parents will escort their children to the front door of the daycare home. The backyard is on limits for daycare. Applicant will escort children through kitchen and dining room/living room #2 to the backyard. The backyard was inspected. The backyard is fenced all around. LPA observed large backyard area for play with four play equipment's (including slide, swings, juggle gym), one locked shed with windows (dog home), bbq pit (covered), and several tricycles and table. There are three pets (three dogs and two cats) in the home. Applicant states pets will not be interacting with children. LPA observed no bodies of water on the premises. Off Limit Areas: All bedrooms #1-#4 (safety latches and locks), bathroom #2-#3 (safety latches), laundry room (safety latch), dining room/living room #2 (safety gate), front yard, garage (safety knob), and kitchen (safety gate).

Others: Current Pediatric CPR/First Aid are on file. Preventive Health and Safety Training, Mandated Reporter, and Immunizations for TDAP and MMR are on file. Postings: Emergency Disaster Plan, Earthquake Preparedness Checklist, and Notification of Parent's Rights. LPA did observe a parent board. The Safe Sleeping Regulation was shared with the Applicant.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 367700527
VISIT DATE: 01/08/2026
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Fire extinguisher observed is a 2A10BC reading in the green which does meet Fire Marshall standards, located in the wall in kitchen. Fire Marshall has approved the home, inspected on 1/7/26. LPA has received the approved inspection form dated 1/7/26. First Aid Kit observed located in kitchen top cabinet inaccessible to children. Incidental Medical Services (IMS) policy was discussed.

The following information was discussed with the Applicant:

The following were discussed: No smoking, infant walkers, johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties. Applicant was reminded about ensuring proper care and visual supervision at all times.



Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 367700527
VISIT DATE: 01/08/2026
NARRATIVE
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The Applicant was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Applicant was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed the 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. Provided Applicant with an Infant Sleep Plan form LIC 9227 and the sleep log.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 367700527
VISIT DATE: 01/08/2026
NARRATIVE
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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: https://www.ada.gov/resources/child-care-centers/.

Applicant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Applicant confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541

The Applicant was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

To report UIRs or if you have any questions, please contact Palmdale Regional Office at 661-202-3318. Monday-Friday 8:00am to 5:00pm.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SALAZAR FAMILY CHILD CARE
FACILITY NUMBER: 367700527
VISIT DATE: 01/08/2026
NARRATIVE
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The home does meet Title 22 Regulations. The Applicant is ready for licensure.

An Exit interview was conducted: A copy of this report was read, and provided to Un Salazar, Applicant.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
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