197418421-10-11-2023-30-CC-VWHY-CWHQLH-20231011121554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418421
Report Date: 10/10/2023
Date Signed: 10/11/2023 12:16:06 PM

Document Has Been Signed on 10/11/2023 12:16 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	197418421
ADMINISTRATOR:	CHERYL MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 818-9398
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	14	CENSUS: 5	DATE:	10/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Cheryl Martinez		TIME COMPLETED:	02:45 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 October 10, 2023, Licensing Program Analyst (LPA), Veronica Wheatley conducted an unannounced Annual Required Inspection and was met by Licensee, Cheryl Martinez. Licensee husband and adult daughter were also present and supervising children. Days and hours of operation are currently Monday through Friday 8am to 5:30pm. LPA toured the home inside and outside and a census was taken. LPA observed 5 children on the premises of which one child is are under 2 years old. Current facility sketch reviewed and confirmed that the living room, dining area and the kitchen are used for the children. Also, the children utilize the "Rainbow Room" which is the detached room in the rear. The children use this room as an activity room but they do not eat or sleep in there. This room has a portable heater and portable air conditioner. There is one dog on the premises which is kept in bedroom. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises per licensee. There is one dog on the premises kept inside a bedroom. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible with locks. There is a working fire extinguisher, smoke detector, and carbon monoxide detector. The home has adequate heating and ventilation (central heat and central air) for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number. LPA discussed Safe Sleep Regulations with licensee. Cribs and play yards will be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants up to 2 years old every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPA observed one infant on the premises.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197418421
	VISIT DATE: 10/10/2023

NARRATIVE

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expires 9/2025. Licensee’s pediatric CPR/First Aid expires on 12/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed with the licensee the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted. A copy of this report will be provided to the licensee.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC809 (FAS) - (06/04)

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