013417134-8-10-2022-52-CC-EWOS-CH6QK3-20220810121339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417134
Report Date: 08/10/2022
Date Signed: 08/10/2022 12:13:56 PM

Document Has Been Signed on 08/10/2022 12:13 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, 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: 0	DATE:	08/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Maria C. 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 August 10, 2022 at 10:20 AM, Licensing Program Analyst (LPA) Elimika Woods arrived at the home for an unannounced 1 Year Required Inspection. LPA Woods met with the licensee Maria C. Martinez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was licensee's fingerprint cleared husband, J. Martinez, and three (3) grandchildren. Licensee stated that the facility operates from Monday to Friday 7AM to 6 PM. LPA toured the facility to conduct a Health and Safety inspection. This single story home was clean and orderly, with heating and ventilation for the safety and comfort. The Isolation area will be the bedroom near the entrance, away from other children in care. The outdoor play area is the fully fenced backyard and is free from defects or dangerous conditions. On-limit-areas are the: Master bedroom, bathroom, family room, kitchen, middle and lower backyard area, and Bedroom at the front entrance of home Off-limit-areas are : First bedroom to the left of hallway, single bedroom unit in backyard, left upper side of backyard area The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. 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. There are ample age appropriate toys that appear to be safe and in good condition. See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARTINEZ, MARIA C.	FACILITY NUMBER: 013417134
	VISIT DATE: 08/10/2022

NARRATIVE

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The home has a fully charged 2A10BC fire extinguisher, dual working smoke detector/carbon monoxide detector, and telephone. There’s a fireplace in the family room with a barricade to prevent access by children. Per licensee, there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. All required forms are posted and visible for public review.

The outdoor play area has a swing that is anchored with cushioning to absorb children falls and trees for shade. There's a lock shed on the lower level that stores equipment that is inacessable to children.
No children files were reviewed because licensee has not enrolled any children and no fire and disaster drills have been conducted. The licensee was informed by the LPA to conduct drills once children are enrolled once every six months. The licensee is in ratio today. The licensee stated that she completed mandated reporter training but could not provide to LPA Woods. Licensee's CPR and First Aid certificate is current and expires 10/ 2022.

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 is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

California Law requires Family Child Cares Homes 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.

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

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MARTINEZ, MARIA C.	FACILITY NUMBER: 013417134
	VISIT DATE: 08/10/2022

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.

There are no deficiencies cited. 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 C Martinez.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

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