013416161-6-25-2019-52-CC-LDYN-BDGTM5-20190625145035

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013416161
Report Date: 06/25/2019
Date Signed: 06/25/2019 02:50:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MARTINEZ, MARIA LUISA		FACILITY NUMBER:	013416161
ADMINISTRATOR:	MARTINEZ, MARIA LUISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 583-9126
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	14	CENSUS: 10	DATE:	06/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Maria Luisa Martinez		TIME COMPLETED:	03:00 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 6/25/19 at 1:08pm, Licensing Program Analyst Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with the licensee. The licensee's fingerprint cleared assistant A. Vasquez arrived and assisted with interpretation. The licensee's fingerprint cleared husband, fingerprint cleared assistant J. Ochoa, 10 children were also present. At 1:18pm, LPA began a tour of the areas of the home used for the child care, to conduct a health and safety inspection. The home is neat and clean with sufficient heating and ventilation for the safety and comfort of children in care. The on limit areas include the family room, the bathroom on the left side of the hallway, and the first two bedrooms on the right side of the hallway. The kitchen, dining room and living room are used for walk thru to the bathroom. All other areas of the home are off limits, and are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be a section of the family room, away from other children in care. The fully fenced backyard is used for outdoor play and it is free from defects or dangerous conditions. There are two locked sheds in the backyard. LPA observed a good supply of toys and activities available for children, and they appeared to be age appropriate, safe and in good condition. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. The fireplace in the living room is gated to prevent access by children. There are no heaters accessible to children. Per the licensee, there are no firearms in the home. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, fully stocked first aid kit and telephone. At 1:45pm, LPA reviewed the files of 5 children in care, and verified that all files include updated immunization records. The licensee's CPR/first aid certificates are current and expire on 8/14/19. The licensee conducts and documents fire and earthquake drills at least once every six months and the log indicated that drills were conducted on 4/3/19. The licensee and both assistants have the required immunizations in file. continued on 809C

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARTINEZ, MARIA LUISA	FACILITY NUMBER: 013416161
	VISIT DATE: 06/25/2019

NARRATIVE

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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. The licensee stated that there are no children enrolled at this time, who require medication while in care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensee was advised of the required mandated reporter training to be completed as of 1/1/18, at www.mandatedreporterca.com.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy. LPA reviewed the ratio and capacity of the license, and reminded the licensee that if an assistant is not available the capacity reverts back to the requirements for a small family child care home.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted with the licensee.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

LIC809 (FAS) - (06/04)

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