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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629031
Report Date: 04/21/2021
Date Signed: 04/21/2021 05:29:48 PM

Document Has Been Signed on 04/21/2021 05:29 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, KRISTAN KARISSA FAMILY CHILD CAREFACILITY NUMBER:
376629031
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Kristan Martinez, ApplicantTIME COMPLETED:
04:21 PM
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On April 21, 2021 at 3:01 PM, Licensing Program Analyst (LPA), Marie Hernandez conducted an announced Tele-Conference Pre-licensing and RAST Inspection due to the COVID -19 State of Emergency via FaceTime with the Applicant, Kristan Martinez. The purpose of the inspection is to ensure the home is incompliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This is a one story three bedroom and two bath home that was toured and inspected. The hours of operation are Monday through Friday, from 6:30 AM to 5:30 PM. The Applicant will use the following areas for childcare: The living room, day care room, the hallway bathroom #1, and the side yard. The off-limit areas are bedrooms #1, #2, #3, bathroom #2, kitchen, garage, and part of the backyard. The off limit areas are inaccessible to children through the use of child proof locks and a child proof gate. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B:C and is located in the hallway closet. The required smoke detector and carbon monoxide detector are operational. All poisons, detergents, cleaning compounds and medicines are secured, inaccessible and out of reach of children. Age appropriate toys and play equipment are available. A working telephone is available. The Applicant indicated there are no firearms or weapons in the home. The Applicant maintains documentation of proof of control of property for review by the Department. Discussed the Mandated Reporter AB1207 online training. The AB1207 must be renewed every two years. The Applicant completed the 8 hours of preventative health. The pediatric CPR and First Aid certification expires 01/09/2023. The required documents are posted. The Applicant and the adult residents have the criminal record clearances on file. The Applicant was advised that any new/additional adults must be cleared prior to working or residing in the home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and are incompliance. LPA advised that prior to making alterations or additions to the home or grounds, the Applicant shall notify the Department of the proposed changes. The Applicant states she is financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2021
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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE
FACILITY NUMBER: 376629031
VISIT DATE: 04/21/2021
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The Applicant does not plan on providing Incidental Medical Services (IMS) to children at this time. 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. Megan’s Law was discussed meganslaw.ca.gov.

A New Provider Resource Packet was reviewed with the Applicant including information on the following: Safe Sleep, Lead Exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunization's, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log and prohibited items including no smoking or corporal punishment in a day care. LPA discussed the maximum capacity for a small family child care home: four infants only (infant means any child under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. Discussed and provided the Covid-19 postings.

The Applicant is advised to regularly visit the Community Care Licensing WEBSITE:www.cdss.ca.gov for quarterly updates and updated regulation information. The Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided, and the Applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. The Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The Applicant is ready for licensure effective today 04/21/2021. LPA Marie Hernandez explained the inspection report, and the Applicant stated she understood. An exit interview was conducted, and a copy of the report was emailed to the Applicant. The Applicant was advised that acknowledgement of the receipt of the report is to be received within 24 hours. NOTE on Facility Signature: SEE FILE FOR ACKNOWLEDGEMENT.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC809 (FAS) - (06/04)
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