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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408673
Report Date: 06/14/2023
Date Signed: 07/11/2023 11:34:16 AM


Document Has Been Signed on 07/11/2023 11:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 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: 7DATE:
06/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:47 PM
MET WITH: Sandra Diaz MartinezTIME COMPLETED:
04:52 PM
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Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced Annual Inspection at the above facility to ensure that health and safety standards are being met as required by regulations, statutes, and requirements governing California family childcare homes according to Department Regulations and Safety Codes. Upon arrival, LPA met with Licensee. LPA explained the purpose of the inspection, and there were seven children in care and three adults At the time of the Inspection there were currently no infants in care. LPA explained in detail in CARETool regarding safe sleep. LPA was guided on a tour of the on and off-limits areas of the home inside and outside by Licensee. Licensee provides breakfast, lunch, and snack.

The following was observed and discussed with the Licensee during the inspection


Home is a 1 story dwelling that includes the following:
· 3 bedrooms (2 off limits)
· 2 bathroom (1 off limits).
· 1 kitchen (off limits)
· 1 living-room, and main day care in back room the primary care area (on limits)
· 1 front yard (off limits).
· 1 Back yard

The following was also observed by LPA during the inspection


1. All adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
2. Home is neat and clean.
3. Heat vents were screened.

4. Home is equipped with a fully charged fire extinguisher that is a 3A:40 B: C


5. Home is equipped with a working smoke alarm and a carbon monoxide detector.
6. Home has a working telephone.
7. All poisons are locked Page 1
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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Document Has Been Signed on 07/11/2023 11:34 AM - 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
L.A. DAYCARE-NO.WEST, 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: 06/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (observation interview, the licensee did not comply with the section cited above in 3out of 3 identifierswhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2023
Plan of Correction
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Licensee will have have staff take mandated reporter training and email certificate .
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 [(observation) (interview , the licensee did not comply with the section cited above in 3] out of 3 (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2023
Plan of Correction
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 Licensee will email copies of immunizarion records.
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: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673
VISIT DATE: 06/14/2023
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8. Hazardous materials are kept out of the reach of children (inaccessible):
Kitchen cabinets are equipped with latches.
Bathroom cabinets are equipped with latches.
9. According to the licensee, there are no weapons or firearms at the home. None were observed by LPA.
10. Back yard
11. No bodies of water were observed during the inspection.
12. Toys and playthings are safe, clean, and appropriate for the age of the children.
13. Licensee agrees that no babywalkers, bouncers, jumpers, and similar items will be used for children in care and are kept inaccessible.
14. LPA did not observe preventative health and safety training certificate or Mandated Reporter Certificate. LPA also observed 1st Aid and CPR card(s) that expire on 05/2024. LPA was only able to review one file. Licensee could not find the other two files. One staff did not have the mandated reporter training or any immunization records with immunizations. LPA observed 6 files for the children. LPA provided to the licensee Forms/ Records to Keep in your Family Child Care Home. There were two infants at the facility that did not have the LIC9227 form. LPA shared all information regarding the handout od frequently asked questions for safe sleep.
15. The home is equipped with a first aid kit.
Licensee was reminded of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was referred to LIC 311D: Records to Be Maintained At The Facility - Family Child Care Home.
Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (sudden infant death syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.
Licensee was also reminded that only children eating may be in highchairs and that car seats are utilized only for transportation.Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations. Page 2
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673
VISIT DATE: 06/14/2023
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Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov
Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.


At this time, the facility does not provide Incidental Medical Services - IMS.
The following was thoroughly discussed with the licensee
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.htmhttp://www.ada.gov/childqanda.htm

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders

Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com Page 3

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DIAZ MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197408673
VISIT DATE: 06/14/2023
NARRATIVE
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The following was discussed with the licensee:
· Entrance Checklist- Family Child Care Homes
· CARETOOL
· Safe Sleep Frequently Asked Questions
· Forms Records to keep in your Family Child Care Home (LIC311D)
Exit interview was conducted with Licensee. Please see the D- Page for deficiencies.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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