197410498-3-13-2025-58-CC-DDOG-DEQRJB-20250313130341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197410498
Report Date: 03/13/2025
Date Signed: 03/13/2025 01:03:59 PM

Document Has Been Signed on 03/13/2025 01:03 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	COLBY-MARTIN FAMILY CHILD CARE		FACILITY NUMBER:	197410498
ADMINISTRATOR/ DIRECTOR:	COLBY-MARTIN, KENISHIA S.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 753-8308
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	03/13/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Licensee Kenisha Colby-Martin		TIME VISIT/ INSPECTION COMPLETED:	01:20 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	Licensing Program Analyst(LPA) Dawn Dowling and Licensing Program Manager (LPM) Raul Navarro conducted an unannounced annual required inspection at the above facility on 3/13/2025 at 9:15 AM, Licensee Teacher Assistant Saralee Robinson answered the door and indicated licensee would be right out. Licensee Kenishia Martin came out, LPA Dowling introduced herself and LPM Navarro. LPA Dowling provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. Family members residing at facility are: 1 adult and 1 child ). There were 8 children and 2 adults present when LPA arrived. Facility capacity is in compliance for a large Family Child Care Home. Hours of operation are Monday through Friday 7:30 am to 4:30 pm . LPA toured the home inside and outside. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, laundry room, back recreation room used for day care has bathroom and sink for children’s usage, garage, front and backyard (fenced). Per Licensee, areas off limits to children and parents include: 3 Bedrooms, 2 bathroom, dining room, living room, laundry room, garage, front yard. On Limit areas are Kitchen(Licensee will provide photographs of knob covers); back recreation room ,back yard and side of house driveway area that is fenced in. The bathroom that children use is located in back recreation room was observed to be clean and free of hazards. Page 1

Raul Navarro	TELEPHONE: (424) -30-3072
Dawn Dowling	TELEPHONE: (424) 301-3202
	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: COLBY-MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197410498
	VISIT DATE: 03/13/2025

NARRATIVE

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Food is provided by Licensee. Children do not bring food from home due to food program center uses. Refrigerator was inspected for spoiled and outdated food. None observed.

Individuals residing in the home have been discussed and noted. Licensee resides in home with minor grand child. All areas identified that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 2/7/2025.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was purchased on 3/19/2024( Licensee indicated she has purchased a new one will take picture and provide to LPA via email).

The home maintains telephone service via land line and cell phone. The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. LPA observed that detergents, cleaning compounds and medication are stored in laundry room, inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in back recreation room in area near bathroom or at an empty desk, away from the other children. Per Licensee/FR there are no firearms or weapons stored in the home.

Infant Care: Currently licensee cares for 1 infant. LPA observed no play yards/cribs center uses mats . Napping equipment does not block entrances or exits. Mats observed to be firm with tightly fitted sheets.

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SUPERVISOR'S NAME: Raul Navarro	TELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Dawn Dowling	TELEPHONE: (424) 301-3202
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: COLBY-MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197410498
	VISIT DATE: 03/13/2025

NARRATIVE

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Mats were observed to be firm with tightly fitted sheets and blankets. LPA did not observe cribs/play yards. There are currently no infants with pacifiers. Per License wet or soiled sheets are bundled up and placed in bag for parents to take home and wash. Each child has their own bedding. Bedding is washed every week. LPA informed licensee of the new Safe sleep regulations 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Licensee did not know that 15 minute sleep check was required once child was 12 months or older. Licensee has 1 child under 24 months and will start documenting 15 minute sleep check. Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights. Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful, and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
Incidental Medical Services (IMS) policy was discussed. 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.
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SUPERVISOR'S NAME: Raul Navarro	TELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Dawn Dowling	TELEPHONE: (424) 301-3202
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: COLBY-MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197410498
	VISIT DATE: 03/13/2025

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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 of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. 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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee confirmed that there are no Registered Sex Offenders living in the facility and no one smokes ,LPA completed the RSO profile in FAS.

Exit interview was conducted with licensee, asked if Licensee had any questions.

Licensee was advised the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.

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SUPERVISOR'S NAME: Raul Navarro	TELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Dawn Dowling	TELEPHONE: (424) 301-3202
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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