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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700105
Report Date: 12/07/2022
Date Signed: 12/07/2022 12:09:28 PM

Document Has Been Signed on 12/07/2022 12:09 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197700105
ADMINISTRATOR:MARTINEZ, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 939-1869
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/07/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Virginia MartinezTIME COMPLETED:
12:15 PM
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On 12/07/2022, Licensing Program Analyst (LPA)Isabel Ortega met with Licensee, Virginia Martinez for the purpose of conducting a required compliance review inspection. This is as part of the Licensee's probation status (effective 06/22/2022 until 06/22/2024). LPA toured the facility, inside and out, records were reviewed. Upon entry LPA observed 4 children in care and two staff. Family Child Care Home operates Monday through Friday varied up to 23 hours depending on parent's need and Saturday from 8:00am - 4:00pm. Per licensee she is currently enrolled in the Nutrition program and provides breakfast, morning snack, lunch, afternoon snack and dinner as needed.

During the period of probation, the Department is in its sole discretion and may conduct unannounced site inspections for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of a child care facility.

Licensee shall ensure that all individuals working, residing, or volunteering in the facility shall obtain criminal record clearances or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
VISIT DATE: 12/07/2022
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following...To be treated with dignity in his/her personal relationship with staff and other personal... During inspection LPA observed licensee approach children and interact with children in a calm voice. LPA observed positive child and licensee interactions, for example "lets built a tower", "you can do it," "Be careful", "be nice", "we share", ect.

Licensee shall maintain current personnel records of each employee at the facility and ensure that all employees have a current certificate of CPR and First aid training on file at the facility. Licensee’s Mandated Reporter certification is dated 3/9/2022 and CPR/First Aid is current expires 6/28/2023.

Licensee is required to maintain an accurate, complete, and current client roster which must be made available to the Department upon request.

An exit interview was conducted with licensee Virginia Martinez. A copy of this report along with notice of site visit were provided.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC809 (FAS) - (06/04)
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