197494503-3-2-2020-30-CC-VWHY-BMBR6H-20200302114447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494503
Report Date: 02/26/2020
Date Signed: 03/02/2020 11:44:54 AM

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:	197494503
ADMINISTRATOR:	MARTINEZ KAMBY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 210-9473
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	14	CENSUS: 0	DATE:	02/26/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kamby Martinez		TIME COMPLETED:	11:00 AM

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), V. Wheatley conducted a prelicensing inspection for an relocation. LPA met with the licensee at 9:45. The licensee is the only adult present today and no day care children were observed. All adults that reside in the home have a fingerprint clearance. The applicant rents the property and verified with a lease agreement. LPA toured the home indoors and outdoors. The two bedroom and one bathroom house is clean, orderly and comfortable. The licensee is a member of the Gardena Child Care Program. LPA observed a working smoke detector, carbon monoxide, telephone and charged fire extinguisher. The children are allowed in the living room and dining area only. The bedrooms are off limits and have door knob covers. The kitchen is off limits. The home has a wall heater which is properly screened. LPA observed age appropriate toys and a first aid kit on the premises. All detergents, cleaning supplies, medications and sharp objects are inaccessible. The cabinets have child proof locks and the dining room table has edge protectors. The electrical outlets are covered and inaccessible. The children will nap on cots. LPA observed door knob cover on the closet door in the hallway. Per the licensee, there are no firearms on the premises. LPA inspected the fenced front yard. The yard has all dirt. The children will not play on the yard until it is covered with mats or artificial grass. The applicant will send pictures when this has been done. There are no pets on the premises and no bodies of water.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

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: 197494503
	VISIT DATE: 02/26/2020

NARRATIVE

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Applicant was informed in great detail in regards to Incidental Medical Services. Licensee states there are no children receiving I.M.S. services. Licensee understands if any children enroll that require I.M.S. a written operational of plan must be submitted to the department.
LPA discussed personal rights, proper discipline, reporting unusual incident reports, etc. Applicant was informed that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). The Safe Sleep brochure was provided. No smoking is allowed on a day care premises. Never shake a baby to prevent Shaken Baby Syndrome. Only children eating may be in high chairs. Provider is required to wash hands after every diaper change.

LPA reviewed child's records which are complete. Applicant has required immunizations and has completed Mandated Child Abuse Training. Applicant has current CPR, first aid, health and safety which expires September 2021. Applicant states she is receiving the Child Care Quarterly updates and handout the Effects of Lead Poising to parents. Additional information may be obtained at the department's website www.ccld.ca.gov

The required documents shall be posted on the parent board.

A fire department clearance has been approved. LPA observed a pull down fire station.

A license for large will be granted once the internal 850 document has been received.

Exit interview. A copy of report provided to the licensee.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

LIC809 (FAS) - (06/04)

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