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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494436
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:35:09 PM

Document Has Been Signed on 05/20/2022 02:35 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197494436
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth MartinezTIME COMPLETED:
01:20 PM
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On May 20, 2022 at 11:00am, Licensing Program Analyst (LPA) Veronica Wheatley conducted an announced Prelicensing inspection and met with licensee Elizabeth Martinez for an increase in capacity. The licensee's assistant Staff #1 was also present and assisting with the children.

The licensee resides in the home with her husband and three children. Licensee was reminded that all adults living and working in the home must obtain criminal record clearances.

LPA Wheatley was guided on a tour of the entire inside and outside of the home. The home is single story, four bedroom, and two bathroom house. According to the licensee, the primary day care is conducted in the living room, dining room, and den. All the bedrooms are off limits and inaccessible with child proof locks. LPA observed age appropriate toys napping cots and first aid kit. The kitchen is off-limits with a child proof gate. LPA observed all chemicals, cleaning supplies, and any other hazardous items inaccessible to children. Licensee was reminded the importance of this safety and regulation. LPA inspected the backyard which is safe with a play structure. There is a separate area for three dogs and is inaccessible to the children. There are no bodies of water. According to the licensee there are no firearms.

LPA Wheatley observed the following:
*Fire safety requirements: Three fully charged fire extinguishers (Classification: 2A10BC), smoke and carbon monoxide detectors present and operable. The licensee is conducting fire and earthquake drills once a month. LPA observed the drill log.
*Licensee is currently certified in Pediatric CPR/First Aid which expires 11/20223 and has completed the preventive health and safety training, and childhood nutrition training.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494436
VISIT DATE: 05/20/2022
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The following items were thoroughly discussed with the licensee:

*The necessity of earthquake safety and drills twice a year
*The role and responsibilities of being a mandated reporter
*Mandatory Forms for the children’s files. Records must be kept for 3 years after termination.
*Records are maintained at the facility - Family Child Care Home.
*Licensee was made aware that it is their responsibility, as well as anyone who assists in providing care, to know Title 22 Regulations.
*The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times. If the phone number has changed, licensing must be notified.
*Regulation prohibits the smoking of tobacco on the premises.
*State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.
*Licensee was informed infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome)

Licensee was informed that all provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials19-02 CCP Safe Sleep Awareness Campaign

*Only children eating may be in highchairs and car seats are utilized for transportation only.



*Requirements for fingerprint clearances and associations are discussed. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day up to $500.00 (5 days) for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period.The applicant may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494436
VISIT DATE: 05/20/2022
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Licensee is reviewing the PINS (Provider Information Notices) and the Child Care Quarterly updates.

The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541 and email address: childcareadvocatesprogram@dss.ca.gov

*Licensee was reminded of the requirement to report unusual incidents and/or injuries to the parent/guardian and licensing within the time frame specified by the regulation (LIC 624B)

*The "Notification of Parent's Rights" (PUB394) poster must be posted in an area accessible to parents. *The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.
*LPA discussed AB633 and informed that upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report (LIC 809 or LIC 9099 and copy of LIC 9224 parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
*Complaints shall be reported by applicant/licensee and/or parents to the complaint hotline at (844) 538-8766 and for general information and incident reporting; contact their local childcare office. *Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare 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 inspection.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494436
VISIT DATE: 05/20/2022
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*Incidental Medical Services (IMS) Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders. Incidental Medical Services (IMS) policy was discussed. 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

*New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

Licensee has all of the following items posted in visual view: (1) License (2) Emergency Disaster Plan (3) Parents Rights Poster PUB 394, Personal Rights LIC 613-A. Children's roster is accessible.

The facility is in compliance and only needs to tack down a wire from a wall TV and add a latch to the door to the garage from the day care room. Licensee does have a door knob cover however LPA is recommending a latch which is higher up for inaccessibility to older children. Licensee will be licensed for large capacity


An exit interview was conducted and a copy of the report will be emailed to the licensee with read receipt.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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