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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495272
Report Date: 08/02/2023
Date Signed: 08/02/2023 02:50:07 PM

Document Has Been Signed on 08/02/2023 02:50 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MARTIN FAMILY CHILD CAREFACILITY NUMBER:
197495272
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Applicant Kobi Martin TIME COMPLETED:
03:30 PM
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On 8/2/2023 Licensing Program Analyst (LPA), Dalicia Adkins conducted a pre-licensing visit for a family childcare home. LPA met with applicant Kobi Martin. Applicant is applying for a family child care home with a capacity of eight children. Operation days and hours will be seven days a week and twenty four hours a day.

This is a single level family home with two bedrooms (bedroom #2 is off limits) , one bathroom , kitchen (off limits) , living room ( off limits) , dining room, attached indoor patio (off limits) and detached garage (off limits) . Facility sketch submitted and areas on facility sketch identified. Kitchen is off limits and is made inaccessible by child safety gates. The indoor patio is off limits and is made inaccessible by glass sliding door with two locks. There are two steps that leads down into the patio area. Bedroom #2 is off limits and made inaccessible by locked door.

There are three entrances/exits: one front of the home; one screen door with a lock and wooden door with two locks. There is an entrance/exit on the side of the home near the laundry area; one screen door ( two locks) and wooden door (two locks). The indoor patio has another entrance/exit that leads out to the backyard.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 197495272
VISIT DATE: 08/02/2023
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Children will utilize the dinning room for eating. LPA observed appropriate sized children furniture and in good condition. Bedroom #1 will be used for primary care and children will nap in this room. The children will use mats for napping and pack and play will be used for infants. LPA observed age-appropriate toys and furniture. LPA observed toys and furniture to be in good repair.

LPA observed storage unit with individual cubbies that will be used for children personal belonging. LPA observed parent board above storage with, all required licensing forms posted.

Children will utilize the back yard for outdoor play/activities. The backyard has grass and is gated. LPA observed shaded area that can be for outdoor activities and cool down area. The sides of the home will be off limits and garage will be off limits. There is another area in front of the garage and behind the side gate, this area will be used for some outdoor activity. There is no swimming pool or other bodies of water. The detached garage is off limits and is made by closed/locked garage door.

LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. There is one operable sink and one faucet with running water. Bathroom drawers/cabinets are made inaccessible by child security locks.

The kitchen is off limits. LPA observed knives and sharps stored in cabinet with child safety locks. Food preparation area adequately equipped, clean and free of hazards. Applicant will be providing breakfast, lunch, dinner and snacks. Applicant will be providing bottled water for children in care. Water will be ready and available at all times.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 197495272
VISIT DATE: 08/02/2023
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Per applicant there are no firearms on premises. LPA did not observe any baby walkers, trampolines, or bouncers. There is a fireplace and is made inaccessible by screen, fireplace will not be using during childcare hours. LPA did not observe any pets in the home. LPA observed central air conditioning providing adequate ventilation. LPA observed adequate lighting throughout the home.

All required licensing devices observed. Fire extinguisher (2A 10BC) located near children cubby area. Combo smoke detectors/carbon monoxide detectors mounted on ceiling throughout the home, nine in total. LPA confirmed with applicant that cell phone will be used as primary contact, mobile cell number (323) 646-5624.

Residential and driveway parking will be available for parents during drop off and pickups. Parents will drop off children at the side gate that opens up to area on side of the home.

The following corrections were discussed with applicant for the home to be ready for conducting childcare: cribs/ pack and play and high chairs.



Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 197495272
VISIT DATE: 08/02/2023
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.


Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

LPA discussed Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA proved license with a copy of LIC 311E. LPA discussed safe sleep regulations, copy of individual infant sleeping plan (LIC 9227) given. LPA discussed safe sleep wellness check, a copy of 15 minuet checklist given. Entrance Checklist (LIC 926) was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 197495272
VISIT DATE: 08/02/2023
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A license to operate a family child home will be reviewed following final administrative review.

Exit interview conducted. This report reviewed with applicant Kobi Martin and copy given.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5