013417134-7-17-2019-52-CC-LDYN-BE6UGV-20190717153458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417134
Report Date: 07/17/2019
Date Signed: 07/17/2019 03:35:04 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 C.		FACILITY NUMBER:	013417134
ADMINISTRATOR:	MARTINEZ, MARIA C.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 695-1352
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	14	CENSUS: 1	DATE:	07/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Maria Martinez		TIME COMPLETED:	03:45 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 7/17/19 at 2:20pm, Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with the licensee. The licensee's fingerprint cleared husband and 1 preschool age child were also present. LPA reviewed the file of 1 child in care. The facility roster was reviewed, and a copy was obtained. The licensee's CPR/first aid certificates expire on 10/27//20. The licensee conducts and documents fire and earthquake drills at least once every 6 months, and drills were last conducted in February 2019. All required forms are posted and visible for public review. The licensee has completed the required mandated reporter training. LPA toured the areas of the home that are used for the child care, to conduct a health and safety inspection. The home is a single story home, which is neat and clean and has sufficient heating and ventilation for the safety and comfort of children in care. The on limit areas include the first bedroom on the right side of the hallway, the bedroom at the end of the hallway, the kitchen and dining area, and the hallway bathroom. All other areas of the home are off limits and made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area will be the first bedroom on the right, away from other children in care. The backyard is used for outdoor play, and LPA observed that it is fenced and free from defects or dangerous conditions. The fireplace is in an off limit area, and inaccessible to children by a gate, and there are no heaters accessible to children. LPA observed toys and activities available for children, which are age appropriate and in good condition. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. Per the licensee, there are no firearms in the home. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, telephone and first aid supplies. The 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 the Safe Sleep in Child Care, and LPA discussed some safe sleep practices. 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: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

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 C.	FACILITY NUMBER: 013417134
	VISIT DATE: 07/17/2019

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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.

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 to have it 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: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

LIC809 (FAS) - (06/04)

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