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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408673
Report Date: 05/04/2022
Date Signed: 05/04/2022 05:32:43 PM


Document Has Been Signed on 05/04/2022 05:32 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:DIAZ MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197408673
ADMINISTRATOR:SANDRA DIAZ MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 782-2803
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:14CENSUS: 11DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Sandra Diaz-Martinez-LicenseeTIME COMPLETED:
05:45 PM
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On 5/4/2022 Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced Annual Random/ I year require visit for Diaz Martinez Family Child Care Home. Present in the home was licensee Sandra Diaz-Martinez, assistants Guadelupe Martinez and Elizabeth Bedoy, supervising 11 day care children. The licensee also has a 14 year old minor child in the home. The home is a single family, single story home with three rooms and 1 bath. Day care activities are conducted in a rear rhombus room, children eat and sleep in the home. The home was inspected inside and out for Health and Safety compliance per Title 22.
LPA observed the following:
Care and supervision were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector present & operable.
Detergents, and knives were inaccessible, Toxins were not observed in locked cabinets.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673
VISIT DATE: 05/04/2022
NARRATIVE
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The homes kitchen was not inaccessible to children in care, Licensee has locked cabinets (locks in need of repair). Per licensee children are not present during cooking of meals, meals are prepared prior to children's arrival.
No guns or weapons present as stated by the Licensee, no weapons observed by LPA.
The home has a working
LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, Notification of Parent’s Rights Poster, Lead Poison Awareness, Safe Sleep and California Safety Seat Law were not posted.
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. Licensee’s Pediatric CPR and First Aid Card expired 2/2022, no one in the home had current CPR and First Aid No bodies of water were observed on the premises
Children records available and in good order.
Personal records were reviewed and in need of updating
Per licensee her and her assistance has not renewed their Mandated Reporter certificate and the expired ones were not available
A roster was readily available for review.
Parents and authorized adults do not sign children in and out.
Licensee does(not) provide Individual Medical Services (IMS). IMS was discussed with licensee.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673
VISIT DATE: 05/04/2022
NARRATIVE
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All adults in the home cleared a Criminal Background Clearance.
Toys, equipment and materials available and in good order Children napped in play pens and cots, that were found to be in good condition. Infant safe sleeping was discussed with licensee. LPA reminded licensee that children are only to use car seats during transportation, and appropriate children’s feeding chairs shall only be used during mealtime.

Outdoor activities were conducted in the rear of the home. LPA did not observe resilient cushioning under the climbing apparatus, Licensee was advised to devise a plan to provide cushioning under all fall zones.

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/process.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673
VISIT DATE: 05/04/2022
NARRATIVE
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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.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Sandra Diaz- Martinez

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 05/04/2022 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as LPA observed laudry detergent on the floor making them accessible to chhildren in care,which posed a potential health risk to persons in care. Licensee placed item out of the reach of children during the visit.
POC Due Date: 05/04/2022
Plan of Correction
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Licensee placed item out of the reach of children during the visit.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, per licensee Sandra Diaz-Martinez, fire and earthquake drills are not conducted which poses a potential safety risk to persons in care.
POC Due Date: 05/13/2022
Plan of Correction
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Licensee shall conduct hearthquake and fire drills by the due date of 5/13/2022 and provide a copy of the log to the Regional Office via email or mail.

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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 5 of 8


Document Has Been Signed on 05/04/2022 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above there were no record of immunization for assistant #2 Elizabeth Badoy which poses potential health risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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Assistant #2 shall provide proof of immunization By the due date of 5/27/2022 via email or mail
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onrecord review the licensee did not comply with the section cited above in which poses a potential health risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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assistant #2 Elizabeth Badoy did not have proof if immunization which poses potential health risk to persons in care.

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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
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