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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629391
Report Date: 06/22/2022
Date Signed: 06/22/2022 12:29:35 PM

Document Has Been Signed on 06/22/2022 12:29 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:INZUNZA, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
376629391
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
06/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Martha Inzunza TIME COMPLETED:
12:20 PM
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On 06/22/22 at 10:45 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an announced Pre-Licensing inspection. Upon arrival, LPA met with applicant, Martha Inzunza. Also, present in the home at time of inspection, licensees’ spouse and four children. LPA proceeded to tour this one story, four-bedroom and two-bathroom home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Facility plans to operate from Monday through Friday from 8:00 a.m. to 6:00 p.m.

All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational, per observation. LPA observed required postings posted. There is a fireplace located in the living room. Fireplace is securely screened. Children’s toys and play equipment are safe and age appropriate. There are no bodies of water on the premises of the home, per observation. Applicant confirmed there are no bodies of water on the premises. Children will utilize the front yard for outdoor play. LPA informed applicant to ensure children are supervised at all times during outdoor activities. There are no firearms or other weapons in the home, per applicant. Primary telephone is operational. Pediatric CPR and First-Aid certificate is valid through December 2022. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant has provided proof of control of property. Landlord notification on file. LPA informed applicant if more than 6 children will be cared for the landlord consent (LIC9149) will need to be on file. Applicant has met immunization requirement, per SB792. Applicant has completed the Mandated Reporter Training on May 08, 2022. LPA informed applicant the Mandated Reporter training shall be completed once every two years. See LIC809 continuation page…
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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: INZUNZA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376629391
VISIT DATE: 06/22/2022
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8-hour Preventative Health with lead prevention training certificate is on file and dated June 18, 2022. 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. COVID-facility self- assessment checklist is on file.

Applicant will use the following areas for childcare: dining room, living room, kitchen, bathroom located in hallway of home, and backyard. Off limit areas of the home include: backyard, four bedrooms and bathroom located in bedroom #4. Off limit areas of the home are made securely inaccessible, per observation. Applicant was 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.

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 provided 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 informed applicant in order to access CCLD-Childcare regulations, licensing forms, pay the annual fee to visit the following website: http://ccld.ca.gov. LPA discussed the following with licensee: to sign up for Quarterly Updates and PINs through the department’s website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. LPA discussed California Megan's Law provided the following to a with the following website: www.meganslaw.ca.gov. LPA discussed the safe sleep regulations with applicant 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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
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: INZUNZA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376629391
VISIT DATE: 06/22/2022
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LPA also informed applicant 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. LPA reviewed with applicant 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 applicant.

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 platform.
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.

LPA discussed the following with applicant: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. Applicant acknowledges understanding of the ratio regulations.

Exit interview conducted and report was reviewed with Applicant, Martha Inzunza. After final file review, a small family childcare license will be issued and mailed to applicant
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC809 (FAS) - (06/04)
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