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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009162
Report Date: 12/06/2023
Date Signed: 12/06/2023 12:05:32 PM

Document Has Been Signed on 12/06/2023 12:05 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
192009162
ADMINISTRATOR:MARTINEZ, SONIA TRINIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 971-3297
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 12TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
12/06/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Sonia Martinez, Licensee TIME COMPLETED:
12:30 PM
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On 12/06/2023 at 9:30 AM, Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required Inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and granted entry to facility by Licensee, Sonia Martinez, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. Also present was A1, Licensee's Assistant. There were five day care children, which includes three infants, present during today’s inspection. Licensee states that there are currently 10 children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 24 hours seven days a week. LPA discussed license limitations of not providing care longer than 24 hours at a time. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 09/15/2023.

This is a single story home which consists of two bedrooms and one bathroom, Kitchen/Dining Room, Day Care Room and Living Room. Areas used by the children include the Living Room (located upon entry of the home), Kitchen/Dining Room (located to the right of Living Room), Bathroom 1 (located to the left down hallway), and Day Care Room (located next to Bathroom 1). Per Licensee, areas off limits to children and parents include all bedrooms. LPA observed that there are locks on all bedrooms making these areas off limits to children in care.

Per Licensee, the children will have access to front yard and front porch for outdoor play. At 9:32 AM, LPA observed front yard has grass and concrete surface that is maintained and adequate perimeter fencing through-out the yard. LPA observed plastic play houses, a large trampoline that is maintained, and variety age appropriate toys free of loose and sharp parts available. LPA observed a variety of clothing items, holiday decorations, and other clutter in front yard and porch at time of inspection. Licensee acknowledges state of outdoor play area and states she is decorating at this time and children currently do not have outdoor play time and stay indoors. LPA discussed observations with Licensee and that area would have to be cleaned up first prior to allowing children to use outdoor play area.
Report Continues- Page 1 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009162
VISIT DATE: 12/06/2023
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All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed ceiling fans available through out the home. There is a working telephone maintained in the home. At 9:35 AM, LPA observed Living Room to have sectional couch in the corner, television hanging on wall, entertainment area, and diaper changing table in corner. LPA observed two pack-n-plays in Living Room with two infants in them upon arrival. LPA observed bins for clothes on top of entertainment area. At 9:38 AM, LPA observed Kitchen/Dining Room to have a pack-n-play with another infant in it. Licensee states she provides food to children in care and uses this area for eating. LPA observed child size table and benches available for children eating and adequate food supplies at time of inspection. At 9:40 AM, LPA observed knives stored in low drawer with no child safety lock at time of inspection, which poses an immediate health, safety, and personal rights risk to children in care. LPA discussed observation with Licensee. Detergents, cleaning compounds and medications were stored inaccessible at time of inspection. LPA observed these items stored in high cabinets in the Kitchen. At 9:42 AM, LPA observed Day Care Room to have various tall cubby shelves filled with a variety of age appropriate toys, free of loose and sharp parts. At 9:43 AM, LPA observed tall cubby shelves to not be secured and to be shaky and unstable at time of inspection. Per Licensee, this area will be used for sleeping and overnight care. LPA observed mats stored in corner of the room use for sleeping. At 9:45 AM, LPA observed Bathroom 1 to have adequate supplies and general area safety and sanitation at time of inspection. The Licensee states that there are no poisons to kill bugs/vermins stored in the home. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the age, size, and abilities of children in care.

LPA observed two cats on front porch which Licensee states is neighborhood cats and not her personal pet. Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.

At 9:34 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag dated 03/28/2023. LPA tested dual smoke and carbon monoxide detectors which observed to be in operable condition at time of inspection. LPA observed First Aid kit hanging in hallway and was inventoried for necessary supplies. Licensee has current Pediatric First Aid and CPR valid until 04/2025 and AB1207 Mandated Reporter training completed on 10/13/2022. Proof of immunization against influenza, pertussis, and measles was not readily available during today’s inspection.
Report Continues - Page 2 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009162
VISIT DATE: 12/06/2023
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At 10:35 AM, LPA reviewed 5 of 5 children's records. LPA did not observe LIC 627 in all of the children's files and safe sleep log not kept for 3 of 3 infants in care at time of inspection. Children records and required licensing forms were discussed and necessary documents were provided at time of inspection.

The following were discussed:
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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.



LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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.

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.
Report Continues - Page 3 of 4

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009162
VISIT DATE: 12/06/2023
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AB 1207: Beginning on January 1, 2018, this law 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. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Megan’s Law - Family Child Care Homes

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Licensee, Sonia Martinez.


Report Ends - Page 4 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/06/2023 12:05 PM - It Cannot Be Edited


Created By: Katrina Chicote On 12/06/2023 at 11:08 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation Licensee diid not meet above requirement, at 9:42 AM LPA observed tall cubby storage system in Day Care Room that was not secured making it shaky and unstable at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 01/08/2024
Plan of Correction
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Licensee states she will secure the shelves and provde photo proof to LPA via text by POC date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the Licensee did not comply with the section cited above in 2 out of 2. LPA record review and interview state that her and Assistant do not have immunization records available at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 01/08/2024
Plan of Correction
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Licensee states she will obtain records and provide photo proof to LPA via text by POC date.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/06/2023 12:05 PM - It Cannot Be Edited


Created By: Katrina Chicote On 12/06/2023 at 11:09 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations the above regulation was not met. At 9:40 AM, LPA observed sharp knives and utensils in a low drawer in Kitchen with no child safety lock at time of inspection. LPA observed children in Kitchen through out inspection. This poses an immediate health, safety, and personal rights risk to children in care.
POC Due Date: 12/07/2023
Plan of Correction
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Licensee states she will place a lock on drawer and provide photo proof to LPA via text by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


LIC809 (FAS) - (06/04)
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