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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700105
Report Date: 03/06/2026
Date Signed: 03/06/2026 03:05:05 PM

Document Has Been Signed on 03/06/2026 03:05 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197700105
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 939-1869
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/06/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Virginia Martinez; LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On Friday, March 6, 2026, Licensing Program Analyst (LPA) Hanna Cha met with Licensee Virginia Martinez. The purpose of the visit was to conduct an unannounced Annual/Random inspection of the facility. LPA disclosed the purpose of the inspection to the licensee and toured the facility. LPA observed licensee and assistant providing care and supervision to two infants and nine preschool-age children. The current hours and days of operation are 23 hours/7 days a week, varied depending on family needs. LPA reminded licensee that licensee must stay awake during all hours children are awake.

Physical Plant: This is a one-story family home with a living room, dining room, kitchen, four bedrooms, four restrooms, family room, and an attached garage. The off-limit areas are all four bedrooms, kitchen, and attached garage.

Indoor/Children’s Area: LPA inspected the indoor/children’s area for safety, cleanliness and good repair. Licensee provides children with mats and playpens for napping. LPA observed the carbon monoxide and smoke alarm. Per licensee, there is no smoking in the home. Per LPA observation, the fireplace is barricaded by glass screen. The cleaning compounds stored in high shelves, made inaccessible to children. Per licensee, no firearms/weapons on premises. LPA observed fire extinguisher (2A10BC), fully green.

Bathroom: LPA observed the child care bathroom for safe and sanitary conditions. The toilet and faucet are in good operable condition. LPA reminded licensee to keep all hazardous items inaccessible to children. Soap and towels made available to children.

Kitchen: LPA inspected the kitchen for safety, sanitation, and good repair. LPA reminded Licensee, if food is brought from the child’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Licensee participates in the food program and provides all meals during operational hours. The knives and sharp items stores in high kitchen cabinet, made inaccessible to children. Medication stored in high cabinets, made inaccessible to children.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 03/06/2026 03:05 PM - It Cannot Be Edited


Created By: Hanna Cha On 03/06/2026 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Staff #2 (S2) file did not include documentation of the required immunizations. Per licensee, S2 made appointment to acquire immunization records. Per licensee, S2 start date was 01/05/2026. LPA informed licensee that all employees must maintain documentation of immunizations against MMR, Tdap, and Influenza prior to employment at the facility.
POC Due Date: 03/20/2026
Plan of Correction
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Licensee will provide proof of immunizations for S2 by POC due date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Child #1 (C1) did not have an Individual Infant Sleeping Plan (LIC 9227) on file. Per licensee, parent received form but did not return to licensee. Per licensee, C1 start date at facility was 02/05/2026. LPA informed licensee that an Individual Infant Sleeping Plan must be completed and on file for all infants (12 months and under).
POC Due Date: 03/20/2026
Plan of Correction
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Licensee will send proof of completed Individual Infant Sleeping Plan to the department by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2026


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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
VISIT DATE: 03/06/2026
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Outdoor/Children’s Play Area: The children utilize the backyard for outdoor play. Per LPA observation, there are no pools/spas/bodies of water on premises.

File Review: LPA reviewed Licensee’s file and Staff #2 (S2) file. Per record review, Staff #2 (S2) file did not include documentation of the required immunizations. Per licensee, S2 made appointment to acquire immunization records. Per licensee, S2 start date was 01/05/2026. LPA informed licensee that all employees must maintain documentation of immunizations against MMR, Tdap, and Influenza prior to employment at the facility. Licensee will provide proof of immunizations for S2 by POC due date. A Type B citation issued.

LPA reviewed three children files. Per record review, Child #1 (C1) did not have an Individual Infant Sleeping Plan (LIC 9227) on file. Per licensee, parent of C1 received form but did not return to licensee. Per licensee, C1 start date at facility was 02/05/2026. LPA informed licensee that an Individual Infant Sleeping Plan must be completed and on file for all infants (12 months and under). Licensee will send proof of completed LIC 9227 to the department by POC due date. A Type B citation issued.

LPA verified the background clearances of all adults present. Per record review, last disaster drill conducted on 02/2026. Licensee Pediatric CPR/FA expires 01/2028 and Mandated Reporter training expires 06/2026.

Documents Provided: Entrance Checklist (LIC 126)



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
VISIT DATE: 03/06/2026
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Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations. Also, to enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report (LIC624B) when submitting a report to the department at: www.unusualincidentreport@dss.ca.gov. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven (7) days following the occurrence of any events specified above.

LPA discussed the safe sleep regulations with licensee 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 licensee of the importance of checking for and removing any 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
VISIT DATE: 03/06/2026
NARRATIVE
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During the exit interview, the licensee Virginia Martinez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed an RSO check on FAS.

During this inspection, two Type B citations issued. See 809-D.

A notice of site visit was given and must remain posted for 30 days. Appeal Right given.

Exit interview conducted and report was reviewed with the licensee Virginia Martinez.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026
LIC809 (FAS) - (06/04)
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