013416161-5-11-2023-52-CC-EWOS-CRQQJ7-20230511121215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013416161
Report Date: 05/11/2023
Date Signed: 05/11/2023 12:12:31 PM

Document Has Been Signed on 05/11/2023 12:12 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
OAKLAND SOUTH EAST, 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) 470-3205
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 13	DATE:	05/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria Luisa Martinez		TIME COMPLETED:	12:30 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 May 11, 2023, at 8:30 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Maria Luisa Martinez for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's fingerprint cleared husband C. Martinez, assistant C. Munoz-Gonzalez, four infants and nine preschool age children. Licensee stated that the facility operates from Monday to Friday 7:00 AM to 6:00 PM. LPA toured the facility inside and outside to conduct a Health and Safety inspection. This single story home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The Isolation area of the home will be a section of the family room, away from other children in care. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. LPA asked the licensee does she transport children and the licensee stated that she does not transport children. The home has a working smoke detector, working carbon monoxide detector, first aid kit, telephone and a fully charged 3A40BC fire extinguisher which meets standards established by the State Fire Marshal. There’s a fireplace that has a barricade in the family room to prevent access by children. There are firearms stored at this facility in a locked firearm cabinet in an off-limits area inaccessible to children in care. The licensee is in compliance with the immunization laws which pertains to all childcare providers. On-limit-areas are the: Family room, bathroom on left side of hall, two bedrooms on right side of hallway, and backyard Off-limit-areas are : Two sheds in backyard, kitchen, bedroom (3) on left side of hallway, bedroom (4) on the right side of hallway, living and dining room, two sheds See 809-C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARTINEZ, MARIA LUISA	FACILITY NUMBER: 013416161
	VISIT DATE: 05/11/2023

NARRATIVE

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The OUTDOOR PLAY area is the fully fenced backyard it has trees for shade and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there are no play structures which are required to be anchored. There are two (2) sheds with locks to prevent children access to equipment on the side of the house.

At 9:00 AM LPA requested and reviewed the files of nine (9) children in care. All children files contain Immunization, Parent's Rights, Identification & Emergency Information, and Medical Consent forms. The facility roster was reviewed, and copies were obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 04/10/23. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 7/2023. The licensee has completed mandated reporter training on 07/19/21. All required forms are posted and visible for public review.

The following deficiencies were observed during today's inspection:
At 9:30 AM, LPA observed a child who was not school age arriving to family child care home which made the facility out of ratio.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com

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

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARTINEZ, MARIA LUISA	FACILITY NUMBER: 013416161
	VISIT DATE: 05/11/2023

NARRATIVE

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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.

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.

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/inspection-process.

See 809-D for deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Maria Luisa Martinez.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/11/2023 12:12 PM - It Cannot Be Edited

Created By: Elimika Woods On 05/11/2023 at 11:41 AM

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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARTINEZ, MARIA LUISA	FACILITY NUMBER: 013416161
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(d)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA observed four infants and nine preschool age children in care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/12/2023
	Plan of Correction
1 2 3 4	Licensee shall submit a plan of correction to demonstrate how she's going to maintain the day-care within ratio and capacity by 5/12/23. LPA discussed ratio requirements for a large family child care with licensee.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Elimika Woods

LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC809 (FAS) - (06/04)

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