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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619639
Report Date: 06/30/2023
Date Signed: 06/30/2023 03:33:13 PM

Document Has Been Signed on 06/30/2023 03:33 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MARTINEZ, HERMINIA FAMILY CHILD CAREFACILITY NUMBER:
376619639
ADMINISTRATOR:HERMINIA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 536-3397
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
06/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Herminez MartinezTIME COMPLETED:
03:50 PM
NARRATIVE
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On June 30, 2023 at 12:05 p.m. Licensing Program Analyst (LPA), Leilani Curtis conducted an unannounced Annual Inspection and met with Licensee, Herminia Martinez. LPA also verified that the deficiencies that were cited on LPA Leilani Curtis’s Annual Random inspection dated 06/27/22 have been addressed. Also present was the licensee’s spouse/helper Miguel Martinez. LPA provided the LIC 126, Entrance Checklist to Licensee. There were 3 children in care, 2 who are infants. Facility was observed operating within ratio and capacity. LPA conducted a tour of the home inside and outside per facility sketch. Licensee is using the following areas for daycare: living room, dining area, kitchen, family room, downstairs bathroom and enclosed rear yard. Off-limits areas include: entire upstairs.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. Stairs are barricaded. There is a working telephone/email address. All cleaning compounds, detergents, medications, and poisons are made inaccessible through latches, locks, and/or placed up on high surfaces. The fireplace is screened. The fire extinguisher and smoke and carbon monoxide detector are operational. The storage area for firearms is inaccessible to children and locked. Mr. Martinez states that there is no ammunition for the firearm in the home. The outdoor play area is fenced and free of hazardous items. There are no existing bodies of water present. Children records were reviewed for Emergency Information. One of the three children present does not have a completed and signed LIC700, Identification and Emergency Information form or the LIC627, Consent for Emergency Medical Treatment form. The last documented disaster/fire drill occurred on 2/23/23. The licensee does not maintain current 15-minute sleep documentation. There are no new adults living or working in the home over the age of 18 years. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Pediatric CPR and First-Aid certificates are valid through 8/14/23 for Licensee and Spouse/Helper. Immunization records per SB792 were reviewed.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
Document Has Been Signed on 06/30/2023 03:33 PM - It Cannot Be Edited


Created By: Grace Curtis On 06/30/2023 at 01:54 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, HERMINIA FAMILY CHILD CARE
FACILITY NUMBER: 376619639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. The licensee's helper/spouse Miguel Martinez does not have current mandated reporter certification which meet requirements. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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The licensee states that she will have her helper/spouse complete mandated reporter training and she will send LPA a copy of the competion certificate via email by 7/14/23.
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 and licensee statement, the licensee did not comply with the section cited above. The licensee does not maintain verification of immunization to measles and pertussis for her helper/spouse and pertussis for herself. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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The licensee states that she will submit verification of immunization to pertussis for herself and verification of immunization to measles and pertussis for her spouse/helper Miguel Martinez to LPA via email by 7/28/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/30/2023 03:33 PM - It Cannot Be Edited


Created By: Grace Curtis On 06/30/2023 at 01:54 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, HERMINIA FAMILY CHILD CARE
FACILITY NUMBER: 376619639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of three children present does not have a completed and signed Identification and Emergency information form (LIC700) or Consent for Emergency Medical Treatment form (LIC627). This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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The licensee states that she will have the parent of C1 complete and sign the LIC700 and LIC627. The licensee states that she will forward the completed documents to LPA via email by 7/7/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023


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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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, HERMINIA FAMILY CHILD CARE
FACILITY NUMBER: 376619639
VISIT DATE: 06/30/2023
NARRATIVE
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 The licensee’s helper/spouse Miguel Martinez does not have verification of immunization to measles and pertussis. The licensee does not have verification of immunization to pertussis. Licensee has completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certification and it is in compliance. The licensee’s helper/spouse has not completed mandated reporter training per AB1207.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

LPA reviewed the following with Licensee: Recently Approved Safe Sleep Regulations PIN 20-24-CCP dated 9/15/20. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee is aware that interference with a child’s daily functions, corporal punishment, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

See LIC809D for cited deficiencies.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”. Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, HERMINIA FAMILY CHILD CARE
FACILITY NUMBER: 376619639
VISIT DATE: 06/30/2023
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, 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.

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 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.

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

Exit interview conducted and report was reviewed with the licensee.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023
LIC809 (FAS) - (06/04)
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