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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003331
Report Date: 11/07/2023
Date Signed: 11/07/2023 03:25:14 PM

Document Has Been Signed on 11/07/2023 03:25 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198003331
ADMINISTRATOR:MARTINEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 913-6447
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
11/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Hugo MartinezTIME COMPLETED:
03:45 PM
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On 11/7/2023, Licensing Program Analysts (LPAs), Carolyn Tuba and Stephanie Li conducted an unannounced POC (plan of correction) inspection to ensure the 2 Type B deficiencies cited on 10/11/2023 for an annual visit have been corrected. A COVID risk assessment was conducted. LPAs met with Spouse, Hugo Martinez. LPAs observed no children in care. Licensee was not available, as she was out for an appointment.

During the visit LPAs, were provided with Mandated Reporting Training Certificates that were completed for Licensee, Assistant and Licensee’s spouse which expires October 2025.

LPAs cleared the deficiency on this date and provided a copy of the Licensing Report to Spouse. LPAs also issued POC clearance letter during the visit.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

A notice of site visit was given to spouse and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the Spouse, Hugo Martinez.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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