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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191595058
Report Date: 02/10/2022
Date Signed: 02/10/2022 02:48:44 PM

Document Has Been Signed on 02/10/2022 02:48 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:SALAZAR FAMILY DAY CAREFACILITY NUMBER:
191595058
ADMINISTRATOR:SALAZAR, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 369-7070
CITY:VALINDASTATE: CAZIP CODE:
91744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Maria SalazarTIME COMPLETED:
02:50 PM
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On February 10, 2022, LPAs, Cynthia Reyes and Carolyn Tuba made an unannounced inspection for the purpose of obtaining Licensee's email address and update phone number due to the Department unable to contact and update information needed. Per Licensee, telephone is the same, however she has had the ringer off. Licensee gave her cell phone number as a secondary number (626.407.5425). Licensee states she is not operating at this time and has requested Inactive status from today until next year 02/10/2023. Licensee was given and filled out the form LIC 9211 request for inactive status and return to LPAs on this date. LPAs reviewed the inactive status and conditions with the licensee. LPAs also obtained the licensee email address [email protected]. LPAs advised the licensee to contact the department when she is ready to reopen her day care if it is earlier then the date specified on the inactive status form.

Exit interview conducted with Maria and a copy of this report was given.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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