197417109-9-25-2019-12-CC-IORA-BGCVB8-20190925161707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417109
Report Date: 09/25/2019
Date Signed: 09/25/2019 04:17:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	197417109
ADMINISTRATOR:	MARTINEZ/GUMERCINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	6615339317
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	14	CENSUS: 9	DATE:	09/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Gumercinda Martinez		TIME COMPLETED:	04:25 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) Isabel Ortega, met with licensee, Gumercinda Martinez, who guided analyst on a tour of the facility. This is a two story 4 bedroom, 3 bathroom home with kitchen and dining, living room, formal dining room, laundry room, two family rooms and garage. The garage is used for storage only and no child care activities are conducted at any time in the garages. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 3 adults (licensee, spouse, adult son) LIS Fingerprint cleared). Upon entry to the facility the LPA observed 4 children under care an additional 5 children were dropped off. Main care is provided in the living and formal dining room area (gated area-no access to kitchen or family room). Children use the bathroom located in hallway next to the family room. Children have access to the downstairs family room (only when going to bathroom or backyard) and backyard. Off limit areas include the home's entire upstairs (4 bedrooms, 2 bathroom, laundry, family room) and the garage (safety knob observed). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (garage), medicines (upstairs master bedroom), and hazardous items (sharp knives in kitchen upper cabinet) that can pose a danger to children. Facility roster complete and maintained current. Stairs are barricaded with a child safety gate making it inaccessible to children in care. Fire/earthquake drills are current last drill conducted on 6/27/19 at 4:00PM. According to licensee she currently participates in a Food Nutrition Program. The day care home provides breakfast, lunch, afternoon snack, and dinner as needed. The operating child care hours are Monday - Friday from 6:30 a.m. to 6:30 p.m. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, cleaning chemicals are stored in a closet near the kitchen and maintained closed with a child safety door knob. Medication is stored in the second floor in the master bedroom which is off limits and inaccessible to children in care. Facility fees appear to be current according to LIS as of 9/25/19.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417109
	VISIT DATE: 09/25/2019

NARRATIVE

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Children play in the backyard. There is a grass and concrete area for active play. There are swings and slides. There are two large dogs kept in a separate yard from the children.

Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There are age appropriate toys and napping equipment on the premises mats and cots are available. The required fire extinguisher (2A10BC) Carbon Monoxide detector and Smoke detectors are in operable condition tested at 2:30 PM. Fireplace is properly screened and located in the off limits area. Home has central AC and heat. CPR/First Aid expires 03/2020. The First Aid kit was observed and is complete.

The facility annual fees are current. Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148)

The licensee and Assistant provided proof of immunization against pertussis (TDAP), measles (MMR), and influenza.

Licensee was informed about Mandated Reporter training and handout with website given.

The LPA observed a current child roster. Child files were found to be complete.

The outdoor play area was inspected and was observed to be free of hazards, loose and sharp parts.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than #1 week.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417109
	VISIT DATE: 09/25/2019

NARRATIVE

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Review of the requirement to report Unusual Incidents was discussed. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting a report to the department.

Safe Sleep new regulations coming soon discussed with Licensee and also, new child immunization effective 7/1/19 was discussed copy of new immunization record was provided to licensee.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) 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. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Licensee provided mandated reporter training certificate dated 3/25/19.

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.htm

Child Care Advocates:

To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541
The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was in compliance per Title 22 regulations, a no deficiencies will be cited today 9/25/2019. An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee. Appeal rights were provided and discussed with licensee Gumercinda Martinez.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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