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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494503
Report Date: 12/03/2024
Date Signed: 12/03/2024 05:16:21 PM

Document Has Been Signed on 12/03/2024 05:16 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:
197494503
ADMINISTRATOR/
DIRECTOR:		MARTINEZ KAMBYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 210-9473
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:Kamby MartinezTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On December 3, 2024, Licensing Program Analyst (LPA), Veronica Wheatley conducted an unannounced Annual Inspection and was met by Licensee, Kamby Martinez. LPA observed 10 children with licensee and three assistants. Days and hours of operation are currently Monday through Friday 7am to 5pm.
Capacity as specified on the license is being maintained.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and confirmed that the living room and dining room. All bedrooms are off-limits and made inaccessible. There are no firearms or ammunition on the premises per licensee. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a working fire extinguisher, smoke detector, and carbon monoxide detector. The home has adequate heating and ventilation for safety and comfort. LPA observed screen wall heater and portable heater. There are no stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number. LPA observed a children's roster.

LPA discussed Safe Sleep Regulations with licensee. Cribs and play yards will be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants up to 2 years old every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPA observed 4 infants on the premises today.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494503
VISIT DATE: 12/03/2024
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The licensee states she transports children and has permission from the parents. LPA inspected the front yard which is used for outdoor play. The yard is fenced and there are no hazards to children present. There is no swimming pool or other bodies of water on the premises. LPA observed one small dog which is kept in the licensee's bedroom.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expires 4/2025. Licensee’s pediatric CPR/First Aid expires on 9/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. LPA reviewed assistant file and required documents are in file.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed with the licensee the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Exit interview. A copy of this report was read. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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