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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412996
Report Date: 10/24/2022
Date Signed: 10/24/2022 02:46:52 PM


Document Has Been Signed on 10/24/2022 02:46 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197412996
ADMINISTRATOR:MARTINEZ, LORETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 285-1332
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 6DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Loretta MartinezTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Loretta Martinez, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 5 bedroom, 3 bathroom home with kitchen/dining room, family room, formal dining/living room, laundry room, loft and garage. There is no pool on the premises. Upon arrival LPA observed 6 children with the licensee and assistant #1 .

Physical Plant: Main care is provided in the family room. Children use the bathroom in hallway near the downstairs bedroom. Children have access to the family room, downstairs bedroom, children's bathroom and backyard. Off limit areas include the homes entire upstairs, kitchen/dining room, formal dining/living room, laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible to children in garage), medicines (stored in off limit area upstairs) and hazardous items (stored on top of refrigerator) that can pose a danger to children. Electric fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the downstairs bedroom. Per Licensee there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 10/03/22. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197412996
VISIT DATE: 10/24/2022
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Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack, and dinner are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies stored in the homes off-limits garage. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has turf, concrete and dirt areas for children to play. LPA observed the toys and equipment in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 05/2024. Mandated Reporter was completed 05/16/22. Children nap on mats in the family room.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the visit LPA Dorsey was experiencing problems with his printer. LPA Dorsey read the report to Licensee Loretta Martinez and emailed the Licensee the LIC 809, Notice of Site Visit and Appeal Rights.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
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