197417109-5-25-2022-12-CC-JDOY-CERTUQ-20220525150242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417109
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:02:53 PM

Document Has Been Signed on 05/25/2022 03:02 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 CARE		FACILITY NUMBER:	197417109
ADMINISTRATOR:	MARTINEZ/GUMERCINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 533-9317
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	14	CENSUS: 0	DATE:	05/25/2022
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:	Gumercinda Martinez		TIME COMPLETED:	03:17 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) Justin Dorsey met with Licensee, Gumercinda Martinez , who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 4 bedroom, 3 bathroom home with kitchen, dining room, family room, living room (converted main care area) and garage. There is no pool on the premises. Upon arrival LPA observed 0 children in care. Physical Plant: Main care is provided in the living room (main care area). Children use the downstairs bathroom in hallway near the homes garage. Children have access to the living room, downstairs bathroom and backyard. Off limit area include the homes entire upstairs, family room, kitchen, dining 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 (locked in pantry), medicines (in master bedroom) and hazardous items (sharp knives inaccessible in top kitchen cabinet) that can pose a danger to children. 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 family room. Per Licensee there are no weapon/firearms in the home. The last fire/earthquake drill was completed 05/20/22. Roster complete and maintained current. Bathroom: Bathroom is free of hazards (child care bathroom). Toilet and faucet is clean and operable.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417109
	VISIT DATE: 05/25/2022

NARRATIVE

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Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner (if necessary) 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 are locked in the kitchen pantry. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has a padded playground and concrete for children to play. LPA observed the toys in the backyard to be in safe condition. Per licensee children do not play on the grass in the backyard. LPA Dorsey observed a fenced off-limits area on the right side of the backyard where one Rottweiler/German Shepherd and one Rottweiler are kept

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 05/2024. Mandated Reporter was completed 05/12/22. Children nap on cots in the main care area.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9150, LIC 9227 and Infant Sleep Log.

Licensee Hernandez 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 Hernandez 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 Carr 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.

Exit interview conducted and report was reviewed with the licensee Gumercinda Hernandez.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC809 (FAS) - (06/04)

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