<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409224
Report Date: 11/10/2021
Date Signed: 11/10/2021 12:23:44 PM

Document Has Been Signed on 11/10/2021 12:23 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MARTINEZ, VANESSAFACILITY NUMBER:
073409224
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vanessa MartinezTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cherie Acosta met with applicant Vanessa Martinez for an announced Pre licensing/ Change of location Inspection. Present during the inspection was the applicant and her minor child. Applicant states that the hours of operation will be 7:30am - 5:30pm Monday through Friday.

The home was toured for a Health and Safety Inspection. This is a two story home with an in-law unit. The home consists of the following: first floor - living room. office (room #5), bathroom, laundry room, kitchen, and family room/ child care room; second floor- four bedrooms, three bathrooms, T.V area. Also on the second floor is the in-law unit which has a separate entrance. The in-law unit consists of a living room, bedroom, and bathroom. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS used for child care include the family room/child care room and first floor bathroom. The children will walk through the hallway to access the bathroom. The remainder of the home is off limits to children and will be made inaccessible by use of gates, closed and/or locked doors and visual supervision The ISOLATION AREA will be the library area in the child care room. The fenced backyard will be used for outdoor play. There are age appropriate toys in the home. The home has a hot tub. The hot tub has a cover with locks. There are no firearms in the home as stated by the applicant. LPA did not observe any hazardous materials or toxins accessible to children today. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 3A40BC fire extinguisher. The home has a fireplace that is inaccessible to child. Stairs are gated.
The applicant has current CPR/First Aid which expires 09/23. Applicant completed mandated reporter training 10/11/21. Applicant is in compliance with required immunizations. A copy of the deed was reviewed and shows control of property. Children files were reviewed Safe sleep regulations were provided and discussed with the applicant. Safety precaution in regards to COVID-19 were discussed with applicant.

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MARTINEZ, VANESSA
FACILITY NUMBER: 073409224
VISIT DATE: 11/10/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.



This home is recommended for licensure. The license for this home will be effective today, 11/10/21.

Exit interview conducted with Vanessa Martinez.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2