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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414086
Report Date: 07/23/2025
Date Signed: 07/23/2025 04:14:04 PM

Document Has Been Signed on 07/23/2025 04:14 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:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197414086
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, HEATHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 373-8107
CITY:CASTAICSTATE: CAZIP CODE:
91384
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
07/23/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:41 PM
MET WITH:Heather Martinez
TIME VISIT/
INSPECTION COMPLETED:
04:14 PM
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On July 23, 2025, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility. LPA met with Licensee, who granted access. LPA and Licensee toured the home inside and outside for an Annual Random inspection. Residing in the home are the Licensee, spouse. The home is licensed for twelve to fourteen children. LPA observed six children in active care with licensee during inspection ages 2 ½ to 5 years old. Two children were active in the day care area and monitored and four children were napping. Daycare hours are 6:00 AM-5:30 PM. Monday through Friday. All adults residing or working in the home have Criminal Record Clearance (DOJ/FBI) and Child Abuse Index Clearance and are associated to the facility.
Physical Plant: This is a two story five-bedroom, three-bathroom home with kitchen, dining room, living room, laundry room, and garage. Childcare is provided: in the garage entry on the left upon entry. Napping and eating are conducted outside of the day care area in the living room and the kitchen. Children’s Bathroom: is in hallway on the left. It was observed to be clean, with soap, toilet paper, paper towels, functioning sink and toilet and there were no body washes, shampoos, razors, or other items accessible as hazards. The unused outlets in the home were covered. There are curtains in the day care area. LPA observed age-appropriate toys, furniture, and books in good repair. There was napping equipment in the form of cots and enough for all children in care. The home was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, hazardous conditions. The detergents and cleaning compounds are kept inside the kitchen under the sink with a safety latch.The medicines are kept in off limits bedroom. The windows are screened, free of bugs, cracks, and debris.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414086
VISIT DATE: 07/23/2025
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Fire and earthquake drills were current; Fire drill was last conducted on: 7/3/25 and the earthquake drill was last conducted on: 7/3/25. The child and parent Roster was current and complete with all required information. The fire extinguisher (2A10BC) was full, and needle was inside the green area. It was last inspected on: 3/20/25. Licensee stated the fire inspection was also conducted and the carbon monoxide detector and smoke alarm were tested as operable during the fire inspection. LPA observed the smoke alarm operable. The fireplace is inside the living room observed screened with a glass covering. The home has central air conditioning and heat. The required postings were present on the parent wall. There is a landline phone, and cell phone. The stairs were gated. The fire alarm pull switch was observed on the wall inside the kitchen. There was a single action door handle. The temperature in the room was comfortable.
Kitchen: Inside the Kitchen, the items that can pose a danger to children were made inaccessible with safety latch and the sharp knives were inside the cabinet inaccessible. Per Licensee meals/snacks are not provided and there are no known allergies. The refrigerator and freezer were both working.
Off limit areas: Bedrooms: 1-5, Bathrooms 2 & 3, laundry room and outside area behind the play area and to the right of the home (gated and inaccessible).
Outside: The backyard is completely fenced, and the fencing material is wood and in good repair. Per Licensee, there are pets in the home. LPA observed two small dogs inside Bedroom #1 in a kennel. Per Licensee, the pets are vaccinated and do not interact with the day care children. There is a plastic swing and slide set that is not anchored in the ground. There are toys, bikes, and Little Tikes play equipment and two play slides with grass for cushion underneath. Per Licensee, there is an in-ground swimming pool as a body of water on premises. LPA observed an in-ground pool and in ground spa, as bodies of water on the premises. The pool fence was mesh, observed and measured at 62 inches high and constructed so that the fence does not obscure the pool from view.The gap between the fence was one inch apart. A standard size golf ball does not fit through the holes. The fence or gate swings away from the pool and has a self-close and self-latching device located on top of the fence that was measured at 65 inches from ground to top. There was a 17” life ring and a body hook with a twelve-foot fixed pole. Per Licensee, the pool safety equipment, meets the American Society for Testing and Materials (ASTM) International Standards.There was not a pool alarm or pool safety inspection log available during inspection. Licensee stated they were not aware the alarm or log was needed. There is a shaded rest area with tables and couches.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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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: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414086
VISIT DATE: 07/23/2025
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The air conditioning (AC) unit in the yard was not observed. Licensee stated the neighboring home on the left does have a swimming pool as a body of water. The fencing in between the homes is wood observed sturdy and at least 10 ft. high.
Other Review: Per Licensee, there are no weapons or firearms on the premises. LPA did not observe any in the home. The mandated reporter training was viewed. CPR/First Aid for one staff (Exp: 2/27), and immunizations were viewed as one staff is missing measles. The First Aid kit was observed. LPA viewed staff and children’s files and reviewed there are no small infants in care under twelve months, and no infant equipment observed during inspection. LPA conducted a staff interview with the licensee. Per Licensee, transportation is not provided. Incidental Medical Services (IMS) policy and Safe Sleep regulations were discussed. Per Licensee, the home does not have daycare liability insurance.
The following was discussed with the Licensee:
Maintain capacity and transparency per posted parent rights, Roster requirements (keep updated information always and maintain information for three years), Documentation for disaster drills (fire and earthquake drill are conducted every six months). Maintain mandatory forms, signed, for the children’s/staff files, know the updated Safe Sleep regulations. The role and responsibilities of being a mandated reporter. Supervision is always required for children in care. If food is brought in, it is properly labeled. Check food expiration periodically. Responsibility for knowing the regulations as well as anyone who assists in providing care. Temporary absences shall not exceed 20 percent of the hours that the facility provides care per day. If day care is inactive for an extended period, you may notify Licensing. Inaccessibility of hazards must be constantly reassessed depending on the children in care. If the phone number is changed, or someone moves in or out of the home, licensing must be notified.
Regulations prohibit the smoking of tobacco in a private residence that is licensed as a family childcare home and areas of the day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy rocker seats, exer saucers, bassinettes, and any other items that fall into that category. Safe Sleep regulations require infants to sleep on their back unless specified with LIC 9227 form, no blankets, toys, or pacifiers attached to their clothing and Licensee will observe infants every fifteen (15) minutes and maintain a napping log.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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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: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414086
VISIT DATE: 07/23/2025
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New pool safety regulations require pool safety equipment: fencing, alarm and/or cover, body hook, and life ring that is compliant with the American Society for Testing and Materials (ASTM) International Standards. Licensee will monitor the pool safety equipment daily and complete a pool safety log.

The Licensee 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 Childcare 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.
Type A deficiency: Type A deficiency shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is an immediate risk to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A deficiency to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of the Type A report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) must be placed in the child's file for verification of the Type A deficiency. Failure to do so will result in a civil penalty being assessed.
--Licensee is advised to visit: www.shotsforschool.org for Immunization information.
--Licensee was informed of their responsibility to report suspected Child Abuse (LIC 9108), 1-800-827-8724/760-243-6640. Licensee 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.
--Family Child Care Providers (Disaster Planning information):
https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Child Care Videos: https://ccld.childcarevideos.org
--Licensee advised to visit the CCLD website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414086
VISIT DATE: 07/23/2025
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--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 prior to providing the IMS. 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.
--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-andresources/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.
--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.
--Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

Reminder: The CCLD On Duty Worker is available: Monday through Friday from 8:00 AM - 5:00 PM, at (661) 202-3318 for questions, information, and Unusual Incident Reporting. Once the incident is reported within twenty-four (24) hours via telephone, follow up with a written report via email to unusualincidentreport@dss.ca.gov or via fax to: (661) 202-3810 within seven days.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414086
VISIT DATE: 07/23/2025
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There is one Type B deficiency cited during this inspection for swimming pool requirements. There were Technical Violations issued during the inspection. See LIC 809D pages and LIC 9102 TV pages attached to this report.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit, Appeal Rights were provided to Heather Martinez, Licensee during the inspection. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain the posting will result in $100 civil penalty. During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/23/2025 04:14 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 07/23/2025 at 04:02 PM
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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(I)
Pool Safety
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in the Licensee did not have the pool alarm during inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/30/2025
Plan of Correction
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I will provide proof of the pool alarm by POC date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in S2 did not have measles vaccination during inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/06/2025
Plan of Correction
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S2 will provide proof of measles by the 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.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2025


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