197413350-3-3-2020-30-CC-EHIL-BMCREC-20200303115719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197413350
Report Date: 03/03/2020
Date Signed: 03/03/2020 11:57:33 AM

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:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	197413350
ADMINISTRATOR:	MARTINEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 703-7367
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91303
CAPACITY:	14	CENSUS: 7	DATE:	03/03/2020
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Licensee, Maria Martinez		TIME COMPLETED:	12:10 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 03/03/2020 at 9:45am Licensing Program Analyst (LPA) Ericka Hill arrived at the facility to conduct an Unannounced Annual/Required Visit to inspect the Martinez Family Child Care. LPA met with Licensee, Maria Martinez and was guided on a tour of the inside and outside of the FCCH. LPA Hill observed 7 children being supervised by 2 assistants (licensee and licensee's daughter). The Licensee is currently licensed to care for a Large Capacity FCCH and the hours of operation is 24 hours. Licensee stated that the earliest a child arrives at the facility is 9:00am and the latest a child leaves the facility is 7:00pm. Licensee stated that she is not currently caring for children between the hours of 9:00am and 7:00pm. Applicant's home is a single story, three-bedroom, two-bathroom home with a living room, dining room, kitchen, and backyard playground. There is a detached garage converted into a living space for renters. Licensee stated that she is currently renting her garage to occupants. LPA Hill observed the renters to be fingerprint cleared and associated to the facility. LPA observed the off limits bedrooms and did not observe any visible hazards. LPA also observed the off limit bathroom, located in the front of the house, and did not observe any visible hazards. The bathroom accessible to the children was observed to be clean, safe, and did not contain toxins or hazards accessible to the children. The home is located two houses from the corner, on Valerio Street and Glade Avenue. Families and children enter the FCCH by walking through the driveway front gate, enter the living room, and walking through the kitchen into the childcare area/dining room. Children access the backyard through the Licensee's Dining area/childcare area. At the time of the visit, LPA did not observe any bodies of water on the premises. LPA observed gardening tools and a barbecue pit located in the licensee's backyard separate from the children's play area. LPA advised the Licensee to place a mesh net to assist in keeping the children from accessing that area.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka Hill	TELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

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 6

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: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197413350
	VISIT DATE: 03/03/2020

NARRATIVE

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Family members residing in the home include 4 fingerprint cleared adults (Licensee, Licensee's spouse, and licensee's 2 children). LPA observed age-appropriate toys, bedding, and equipment in good repair for the children. The home was inspected for safety, comfort, cleanliness, lighting, heating and ventilation, and inaccessibility of toxins and hazardous items to the children. Licensee states there are no firearms or weapons of any kind in the facility at the time of the visit. Upon review of child files, LPA observed all required documents according to Title 22 Regulations. LPA in one of the children's files (C2), while C1 was missing Immunization Records. LPA inspected the employee files and did not observe the required documents according to Title 22 Regulations. LPA observed child cubbies, a working smoke detector, a working carbon monoxide, a working telephone, and a fully serviced Fire Extinguisher (serviced on 07/10/2019). LPA observed a small dog gated on the side of the FCCH backyard area. LPA observed Licensee's license, Emergency Disaster Plan, and Notification of Family Child Care (PUB394) on the parent board. LPA observed Licensee's Johnson and Johnson First-Aid Kit to be missing tweezers and a thermometer.

Informational Materials for Licensee:
Baby Walkers/etc Prohibited. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Health & Safety Code 1596.846(b) and (c).
Provider Information Notices (PINs). Licensee was informed that PINs are newsletters informing and updating Licensees about Community Care Licensing Division Regulations. Licensee was made aware that the PINs can be located on the California Department of Social Services webpage at https://cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care
Criminal Record Review. Licensee was made aware that all individuals working, volunteering, or residing in the licensed facility are required to obtain a criminal record review. Title 22 Regulations 102370(d).
Criminal Record Review Violation. Licensee was made aware that if there is an individual observed to be working, volunteering, or residing in the home without obtaining a criminal record review the licensed facility will receive a citation of deficiency and an immediate assessment of civil penalties of $100 per violation per day for a maximum of (5) days by the Department or may result in a denial of the license application or a suspension/revocation of license. Title 22 Regulations 102370(e) and 102370 (f).

{Pg. 2}

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka Hill	TELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197413350
	VISIT DATE: 03/03/2020

NARRATIVE

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Facility Records. Licensee was given a copy of the LIC 311D, Forms/Records to Keep in Your FCCH, informing the licensee about the required documents to be maintained in the facility for employees, children, on the Parent Board. The Licensee was also advised on how to access forms and regulations for FCCH’s online at www.cdss.ca.gov.
Smoking Prohibited. Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Health & Safety Code 1596.795(a).
SIDS & Shaken Baby Syndrome Awareness. 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 to prevent the Shaken Baby Syndrome, Never shake a baby!
High Chair & Car Seat Awareness. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
Parent’s Rights Notification. The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents. Title 22 102419.
Child Care Advocate Program Awareness. 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 to disseminate information on the State’s licensing role, provide information to the public and parents on child care 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
Immunizations Required. Licensee was made aware of SB 792, commencing September 1, 2016, prohibiting 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 (optional), pertussis and MMR (Measles, Mumps, and Rubella). Exemption were also discussed. Health & Safety Code 1596.7995.
Mandated Reporter Required. Licensee was made aware of AB 1207, commencing January 1, 2018, requires all licensed providers, applicants, directors, and employees to complete trainings (General and Child Care Provider) 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 Health & Safety Code 1596.8662. {pg.3}

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka Hill	TELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197413350
	VISIT DATE: 03/03/2020

NARRATIVE

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Incidental Medical Services Awareness. Incidental Medical Services (IMS) policy was discussed. 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, Website: www.ada.gov/childqanda.htm
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. 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 Emptying an Ileostomy Bag.
Lead Bill - Health & Safety Code 1596.7996. Licensee was made aware of AB 2370, requiring a licensed child day care center located in a building constructed before January 1, 2010, to have its drinking water tested for lead contamination and to let parents or legal guardians of children enrolled about the requirement to test and result of the tests.
New Immunization Requirement: Licensee was made aware of SB 277, commencing January 1, 2016, stating personal belief exemptions are no longer an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
New Appeal Process: A facility may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.
Nutrition Requirement. Licensee was made aware of AB 290, commencing January 1, 2016, requiring at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university. Health & Safety Code 1596.8661.

{pg.4}

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka Hill	TELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197413350
	VISIT DATE: 03/03/2020

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Licensing Reports Given to Parents Required. Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility. Assembly Bill 633.
Health Beverages in Child Care: Commencing in 2010, legislation was established regarding nutrition standards for beverages served in licensed child care centers and home. Only unflavored, unsweetened, nonfat (fat free, skim, 0%) or low-fat (1%) milk can be served to children over two years of age. No beverages with added sweeteners, natural or artificial, can be served, including sodas, sweet teas, juice drinks with added sugars, flavored milks and diet drinks. A maximum of one serving (4 to 6 oz. for 1 to 6 years old) of 100% juice will be allowed per day. Clean and safe drinking water must always be available, including meals and snacks. Assembly Bill (AB) 2084.

Closing of Report:
The Applicant was provided with a packet of information detailing the role of a Mandated Reporter, Preventing Drowning, Effects of Lead Exposure, information about the Child Care Advocate Program, baby items prohibited in FCCH, Forms and Records to keep in the FCCH, Public Counsel (legal advice), Notification of Parent’s Rights (PUB 394), FCCH Ratios, Active Supervision Strategies, Safe Sleep Regulation Concept Flyer, Immunization Requirements for employees, safety grids for heaters, car safety seat law, Technical Support Program letter, CDSS Quarterly Update (winter 2020), California School Immunization Record form (blue card), and ways to pay annual fees to CCLD.

At this time the facility was observed to be incompliant with Title 22 Regulations and Health and Safety Code regarding the requirements for employee and child files. LPA cited the FCCH on the basis of Child Records and Personnel Records.
An exit interview was conducted and a copy of this report (LIC809), LIC809-D, and Notice of Site Visit was provided to Licensee, Maria Martinez.
{pg. 5}

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka Hill	TELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197413350
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/03/2020 Section Cited	1 2 3 4 5 6 7	Child’s Records. The licensee shall ensure that there are separate, complete and current records kept for each child attending the child care center. This requirement is not met as evidenced by: Child #1 was missing immunizations record. This poses a potential Health and Safety Risk to the children in care.
Type B 03/03/2020 Section Cited	1 2 3 4 5 6 7	Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. This requirement is not met as evidenced by: S1 and S2 did not have all the required documents in file. This poses a potential Health and Safety Risk to the children in care.
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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: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka Hill	TELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

Page: 6 of 6