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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493847
Report Date: 07/16/2019
Date Signed: 07/16/2019 04:52:56 PM

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 CAREFACILITY NUMBER:
197493847
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
07/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Julie MartinezTIME COMPLETED:
04:40 PM
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On 7/16/2019, Denise Miranda, Licensing Program Analyst (LPA) conducted an unannounced annual/random visit inspection to ensure the health & safety standards as required by regulations governing family child care homes are being met. Upon arrival, at 1:55pm, LPA met with licensee Julie Martinez and licensee’s assistant were present. LPA informed licensee of nature of the visit and was guided on a tour (inside and outside) of the home. LPA confirmed with licensee that all adults residing/working in the home have criminal record clearance. Upon arrival LPA Miranda observed five children were napping in the living room, the assistant was observing napping children.
Licensee stated the facility is operating Monday-Friday 8:00am-5:30pm.
The home is a one story, two bedrooms, two bathrooms home with a living room, kitchen and front yard. Per licensee children are using the living room for eating and sleeping. LPA inspected the play area in the front of the of the house. LPA observed perimeter fencing for safety.
The licensee was reminded that children are to be supervised at all times including when playing outside.
The off-limits area includes: bedrooms#1 and #2 and bathroom#2 located inside of the bedroom#2 and backyard.
At 3:20 pm LPA observed a full charged Fire extinguisher size 2-A:10-B:C Fire Extinguisher full charged in the kitchen, first aid kit located at the playroom area, working smoke and carbon monoxide detector, age appropriate toys. Telephone service, central heating, lighting and ventilation were evaluated and in good condition.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493847
VISIT DATE: 07/16/2019
NARRATIVE
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The licensee states that does not have weapons/firearms in the home and none observed by the LPA.
LPA observed age appropriate toys. No pets.
LPA reviewed the child’s file were not completed.

Licensee states at this time is not providing Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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.



The following was discussed with the licensee:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license and immunization.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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: 197493847
VISIT DATE: 07/16/2019
NARRATIVE
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remodeling, telephone number changes and/or if you move from your home. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.


Licensee informed fire drill to be completed every 6 month and to keep a log and to ensure records for staff and children as well as a roster are kept for 3 years. 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 that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

LPA reminded co-licensee every two year to take the Mandated Reporter training: www.mandatedreporterca.com

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493847
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2019
Section Cited
CCR
102421(a)
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Child's Records - The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:The licensee did not have immunization records for C1 and did not have any records for C2.
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The licensee shall have immunization records for C1 and all required documents for C2 no later than 07//23/19.
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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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
Page: 6 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: 197493847
VISIT DATE: 07/16/2019
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Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community C
are Licensing Division. CCAP participates in many community activities and special projects in order 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

During this inspection, LPA also provided the following documents about 1) A Safe Infant Environment Sleeping, 2) Never ever shake a Baby by California Department of Social Services, 3) California School Immunization Record form CDPH286, 4) LIC311D Forms/Records to Keep in your Family Child Care Home 5) Prohibited items in Family Child Care Homes H&S 1596.846(b) &) Health 6) Drinks doe young Children and 7) Pillow and babies don ‘t mix, 8) Keep me safe and 10) brochure with children ratios

Licensee is licensed to serve up to MAXIMUM CAPACITY 8 children, two (2) of which must be at least 6 years of age and no more than two (2) may be infants; or MAXIMUM CAPACITY 6 children, three (3) of which may be infants; or 4 infants only. Infants are children under the age of 2 years.

The facility was not found to be in substantial compliance per Title 22 Regulations. Please see (lic809D)

A copy of report, a Notice of Site Visit and advisory notes were issued and explained to the Licensee.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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: 197493847
VISIT DATE: 07/16/2019
NARRATIVE
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Licensee was informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits 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, pertussis and measles.


New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be 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 licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:
300 N. Continental Blvd., Suite 290-A
El Segundo, CA 90245

A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. The fire extinguisher type 2-A:10-B:C must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction,

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
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