198021331-10-24-2023-33-CC-VMGA-CWWTTZ-20231024150133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021331
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:01:45 PM

Document Has Been Signed on 10/24/2023 03:01 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MARTINEZ CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	198021331
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/24/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Applicants Veronica Martinez and Patricia Chavez		TIME COMPLETED:	03:15 PM

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This inspection was conducted in Spanish

Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an announced Pre-Licensing inspection at the above facility on 10/24/23 at 01:09 p.m. The purpose of this visit is to inspect and evaluate the facility for initial licensure, applicants Veronica Martinez and Patricia Chavez are applying for a Small Family Child Care Home license. Applicants guided LPA on a tour of the facility. Operation hours will be Monday through Friday 23 hours. Applicants state they will care for children 0 months – 13 years old.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, living room, kitchen, garage, front yard, and back yard (fenced). Per applicants, family members residing in the home are 5 adults and 0 minors. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. Individuals living in the home are identified on the attached LIC811.

• Day care areas: living room, 1 bathroom (located in the hallway), and backyard (fenced).

• Off limit areas: 3 bedrooms, kitchen, front yard, and garage.

**Rooms that are off-limits need to be made inaccessible during operating hours** The Applicants do understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas that will be used by children were inspected for safety, comfort, cleanliness. The living room will be the main day care area. LPA observed age-appropriate toys, equipment, and materials available for children. LPA observed 2 barricaded wall heaters to make it inaccessible to children in care. LPA toured the kitchen and observed applicants placed a well mounted kiddie gate to make the kitchen inaccessible to children. LPA observed child proof locks throughout the kitchen. Children will use the bathroom located in the hallway between bedrooms #2 and #3 of the home.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 198021331
	VISIT DATE: 10/24/2023

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LPA observed the bathroom to be safe and in sanitary conditions. LPA observed child proof locks on the bathroom sink cabinet. There are outlet covers throughout the home. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children were observed to be inaccessible to the children. Ill children will be isolated from other day care children and will wait in the living room until parents arrive.

Per Applicants, there are no poisons on the premises. The applicants were advised that any poisons must be locked with a key or combination lock.

LPA observed (1) fire extinguisher: in the hallway leading to the bathroom. The 2A10BC fire extinguisher was fully charged and was serviced on 10/18/23. Applicants were advised that the Fire Extinguishers must be serviced yearly or purchase a new one and keep receipt.

Per applicants, food will be provided to all children in care. Applicants were advised that if food is brought from the children’s homes, all containers must be labeled with the child’s name and properly stored or refrigerated.

At 01:13 p.m. LPA toured the backyard. Per applicants, children will use the backyard for outdoor play. Currently children use the back yard for outdoor play with adequate shade and age-appropriate play equipment for children in care. LPA did not observe any objects that could be hazardous to children in care. Applicants understand that children should be supervised at all times.

LPA tested the smoke and carbon monoxide detectors at 01:19 p.m. and are in operable condition.

The applicants have completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR expires 08/12/25. There are first aid supplies available located in the living room.

Telephone service is via a cellphone and applicants will ensure there is always a phone available during operation hours. Applicants home is equipped with a ceiling fan and several windows that will provide ventilation. LPA advised applicants to maintain the home at a comfortable temperature for all children in care depending on the weather.

Per applicants, there are no firearms, no weapons on the premises. LPA did not observe any of the above mentioned during this inspection. Per applicant, there are no pets on the premises.

The following was discussed with the applicants:

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 198021331
	VISIT DATE: 10/24/2023

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Applicants were 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.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunization (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.

• Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.

• The fire extinguisher type 2A-10BC must be serviced annually or purchased annually.

• Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

• Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

• Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. LIC624B was provided.

• Fire and safety drills must be performed every six months and documented for review by the Department.

• Smoking is prohibited in a family child care home.

• Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

• No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.

• The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 3 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 198021331
	VISIT DATE: 10/24/2023

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• Isolation for ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

• Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

Inspection Authority: All adults living and working in the home shall be made of aware of the Departments right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The applicant has proof of immunizations. Applicant understands that each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year and record must be kept of vaccine or declination letter.

Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors, and employees to complete training as specified on mandated reporter duties. Mandated Reporter Training must be taken every two years. Training is available at: www.mandatedreporterca.com

Per applicants, they do not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

Infant Care: Applicants state they will care for infants. Applicants stated that infants will sleep in the living room where they are constantly supervised. Appropriate sleeping arrangements and play yards are available once an infant is enrolled. LPA informed applicant that one crib or play yard for each infant in care will be needed. Sleeping equipment shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA informed Applicant that infants cannot be swaddled while in care.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 4 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 198021331
	VISIT DATE: 10/24/2023

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LPA advised applicants that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. Infants under 12 months should sleep mouth up, on their backs, and free of clutter surrounding their sleeping space. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months and PIN 20-24-CCP SP: Recently Approved Safe Sleep Regulations in Effect was explained and issued to the applicants. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the applicant, including but not limited to documentation that shall be maintained. LPA discussed and provided the applicants with a copy of the Child Care Provider’s Guide to Safe Sleep, Never Shake a Baby, and SIDS by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf 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 applicants 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) or (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 reviewed with applicants the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9151).

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 5 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 198021331
	VISIT DATE: 10/24/2023

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INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following: Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213) must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

On this date, 09/06/23, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicants were informed of the MyChildCarePlan.org site, 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

Because the applicants rent/lease the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicants confirm was provided to the property owner/landlord. The applicants obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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 platforms. 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.

Facility is ready to be licensed.

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 6 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 198021331
	VISIT DATE: 10/24/2023

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The applicants’ signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicants Veronica Martinez and Patricia Chavez.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

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