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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214412
Report Date: 10/24/2022
Date Signed: 10/24/2022 02:20:37 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/24/2022 02:20 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SALAZAR FAMILY CHILD CAREFACILITY NUMBER:
426214412
ADMINISTRATOR:MARIA SALAZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 332-0311
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Maria Salazar TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Martina Jimenez conducted an Annual Random inspection and met with Maria Salazar, Licensee. LPA observed 1 child in the home. Licensee stated the child is Licensee's grandchild. There were no day care children present. LPA and licensee toured the home and observed licensee's grandchild, no children other children were present during the inspection..

Licensee stated that day care is currently in inactive status. It was explained to licensee that day care inactive status expired. Licensee stated that she is not operating day care children. Licensee stated the last date licensee cared for children was in December 2017.

Licensee signed required Request for Inactive License Status Form 9211 at the time of the inspection. LPA reminded the Licensee placing her license in inactive status she is to comply with the following conditions:

1. Licensee will not provide child care for which a license is required until license is reactivated.
2. Licensee will continue to pay annual license fees.
3. Licensee will insured all adults working or/and residing in the home during inactive period, have criminal record clearance.
4. Licensee will maintain current CPR & First Aid certification.
5. Licensee will maintain current fire extinguisher and functioning smoke and carbon monoxide alarms.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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