304314414-2-27-2026-06-CC-SGAA-DRPV9Q-20260227151444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314414
Report Date: 02/27/2026
Date Signed: 02/27/2026 03:14:56 PM

Document Has Been Signed on 02/27/2026 03:14 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	MARTINEZ, MACKENZIE		FACILITY NUMBER:	304314414
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 5	DATE:	02/27/2026
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Licensee, Mackenzie Martinez		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/27/2026 at 1:30pm, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced case management inspection for the purpose of increase in capacity from Small Family Childcare Home to Large Family Childcare Home. LPA met with the Licensee, Mackenzie Martinez and was led on a tour of the home. There were 5 children including 3 infants and 2 preschool age children and licensee present during the inspection. A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Operation hours are Monday-Friday, 8:30am-4:30pm. Care and supervision shall be provided to children 3 months of age to 8 years old. There are 2 adults including the licensee and no minors living in the home. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single-story home with 2 bedrooms, sun room (child care room), 1 bathroom, Living room, dining room, foyer, kitchen, back yard, and attached garage. Licensee has designated the sun room as the main child care area and the bathroom and backyard. Areas that are used by children were inspected for safety, comfort and cleanliness. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, MACKENZIE	FACILITY NUMBER: 304314414
	VISIT DATE: 02/27/2026

NARRATIVE

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During this inspection, LPA observed the designated off-limits areas were made inaccessible by child safety latches and safety gates. Licensee stated there are no bodies of water on the premises. The facility has a fireplace inside the living room and is screened by a mesh cover and inaccessible to children. LPA instructed licensee to place a metal screen over the fireplace to ensure extra safety for children in care. There is a working carbon monoxide, smoke detector, and a fire extinguisher (2:A-10B:C) in the home that meet statutory and State Fire Marshall standards

A Capacity Handout for a Large Family Child Care Home was provided licensee.

Licensee’s Mandated Reporter Training certificate expires 02/25/2028 and EMSA approved Pediatric CPR and 1st aid expires for licensee on 05/04/2026.

A Fire clearance (STD 850) was approved on 02/13/2026 by the City of Brea Fire Administration. As per fire marshal inspection, garage may not be used for daycare.

The licensee is required to submit the following two (2) corrections to the licensing office via email by the due date of 03/13/2026.

1. Place a metal screening on the fireplace in the living room.
2. Obtain declarations from two (2) joint tenants stating they do not live in the home.

File will be submitted to management for final approval after all corrections are submitted.

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

A copy of this report and Appeal rights were presented to the Licensee, Mackenzie Martinez.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

LIC809 (FAS) - (06/04)

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