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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700105
Report Date: 05/23/2022
Date Signed: 05/23/2022 05:14:28 PM

Document Has Been Signed on 05/23/2022 05:14 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197700105
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 17CENSUS: 8DATE:
05/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Virginia MartinezTIME COMPLETED:
05:20 PM
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On 5/23/2022 Licensing Program Analyst(LPA) Isabel Ortega, conducted a case management inspection to follow up on citations previously issued. LPA toured the facility licensee, assistant and 8 children were present. LPA reviewed sign in sheets and roster, roster has 17 active children with part time and full time care. According to licensee she is maintaining the 8 capacity at all times at her Family child care Home and will pick up and drop off children accordingly. Licensee submitted a signed declaration. On 5/23/2022. Time sheets are not signed daily and therefore LPA was not able to clear the citation for over capacity Code 102416.5(a). Licensee stated she was never instructed by resource and referral Child Care Resource Center to have parents sign daily but always maintain 8 children.


SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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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