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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419973
Report Date: 08/05/2022
Date Signed: 08/05/2022 03:36:43 PM

Document Has Been Signed on 08/05/2022 03:36 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:
197419973
ADMINISTRATOR:HEIDY MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 916-4050
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Heidy Martinez, LicenseeTIME COMPLETED:
03:00 PM
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On 08/05/22 Licensing Program Analysts (LPAs) Justeene Tamayo and Andrew Alemoh met with Licensee, Heidy Martinez. This is a one story, 4 bedroom, 2 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPAs observed 4 preschool children in care, and 3 school age children. Licensee currently does not have any infants in care but does understand the requirements. Family members residing in the home include 4 adults (licensee, licensee's husband, licensee's son and daughter) and two children. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room, family room, and dining room. Children use the bathroom in hallway on the left. Off limit areas include all bedrooms, bathrooms #2 laundry room, and garage. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety latch) and hazardous items (sharp knives in tool box in upper kitchen cabinet) that can pose a danger to children. Per licensee she currently does not have any medications. LPAs did not observe a fireplace on the premises. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, 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 living room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).
Mariela Ramon
Justeene Tamayo
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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 3
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: 197419973
VISIT DATE: 08/05/2022
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Fire/Disaster drill is complete and maintained current. Last fire/disaster drill was conducted on 0705/22.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs observed the bathroom cabinet sink to have a safety latch. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are under kitchen sink with safety latch. Breakfast, lunch, snacks and dinner are provided. Licensee currently has a food program. Children use mats for nap time in the living room.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. LPAs observed age appropriate toys in the backyard. LPAs observed the side of the home to have turf for play time with a side gate. Per licensee, there are three dogs on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires on 04/28/2023. Mandated Reporter expires on 07/28/2023. There are no window cords accessible to children.
SUPERVISOR'S NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
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: 197419973
VISIT DATE: 08/05/2022
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Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and the Individual Sleeping Plan (LIC 9227). LPAs also discussed and provided licensee a copy of the Safe Sleep PIN 20-24-CCP. Licensee stated currently does not have child care insurance.

Licensee Martinez 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.

LPAs discussed the safe sleep regulations with licensee Martinez 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. LPAs 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 to licensee 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 Heidy Martinez, along with her appeal rights.

SUPERVISOR'S NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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