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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494753
Report Date: 09/17/2021
Date Signed: 09/17/2021 01:37:26 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 GONZALEZ & SANTACRUZ FAMILY CHLD CAREFACILITY NUMBER:
197494753
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
09/17/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Abigail Martinez GonzalezTIME COMPLETED:
01:55 PM
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On 9/17/2021 at 12:15 pm, Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with Abigail Gonzalez Martinez for the purpose of an increase of capacity inspection for 3239 McManus Avenue, Los Angeles, CA 90034. The purpose of this increase of capacity visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The licensee is applying for an increase of capacity; Large Family Child Care Home license for a max capacity of 14. A fire clearance was approved by LA County Fire Department on 6/4/2021. Facility was licensed for a Small (8) Family Child Care Home on 6/8/2021.

The applicant rent/leases the property and landlord consent was received with a copy of the rent/lease agreement.

The capacity of the Large Family Child Care Home is 14. Per the application, at this time, the ages the applicant wishes to provide services for are children 12 months old to 10 years old with the hours of operation of Monday- Friday from 8:00 a.m. to 5:30 p.m. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is a single story, 2 bedrooms, 1-bathroom house, with a living room, dining room, kitchen, laundry room area and detached garage located in the back which is used as an activity room.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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 GONZALEZ & SANTACRUZ FAMILY CHLD CARE
FACILITY NUMBER: 197494753
VISIT DATE: 09/17/2021
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Parents come through main door. Front yard is not gated and is OFF LIMITS to the children in care. Entering the front door you are led to a living room and dining room area that has been designated for the day care. LPA observed a Parent board by the main entrance with all the necessary documents. A fire extinguisher was observed mounted next to the parent board. LPA observed a children’s size table and chairs in the space. A variety of age appropriate toys were observed in the different cubbies. A fireplace was observed to be secured with a metal gate and safety latches making it in accessible to the children in care. A wall heater was observed to be covered and have a metal barricade enabling children to access the wall heater.

Next to the living room Bedroom 1/which has been designated as day care space was observed. Napping cots and soft toys with children’s books were observed. Bedroom 1 leads to the bathroom that children will use.

Bathroom was observed to have a toilet, sink and bathtub with no hazardous materials. Cabinet under the sink was observed to have a safety latch. LPA observed the bathroom to have a second door that leads to bedroom 2. LPA observed door to have a child proof doorknob cover. LPA observed children’s diapers to be labeled and stored in their own space. Licensee stated that diapering does occur in the bathroom.

Bedroom 2, which has been designated as an OFF LIMITS area was observed. LPA informed licensee that door needs to remain locked during the hours of operation. LPA observed a child proof door knob cover making the bedroom inaccessible to the children in care.

Exiting the living room/dinning room area, you are led to the kitchen. Kitchen is used as a walkway to access the back yard. The stove, refrigerator, sink and counter space area were observed and inspected. Licensee prepares meal for the children in the program. A second fire extinguisher was observed in the kitchen space. Kitchen has a closet that is used for storage for program. LPA observed closet to be free of hazardous materials and licensee keeps the door closed and locked during hours of program operation. All cabinets were observed to have safety latch, making them inacessible to the children in care.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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 GONZALEZ & SANTACRUZ FAMILY CHLD CARE
FACILITY NUMBER: 197494753
VISIT DATE: 09/17/2021
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The outdoor space was observed to have a variety of age appropriate activities. LPA observed a detached garage that is currently being used for art activities. LPA observed a working carbon monoxide and smoke detector and all electrical outlets were covered. LPA reminding licensee that only daily activities can take place in the garage area. Next to the house, children’s wooden picnic tables were observed with a variety of bikes and tricycles. Toward the back of the yard, a sand box was observed, and a pretend kitchen area was inspected. LPA reminded licensee to make sure plant area is kept clean and trimmed to ensure the safety of the children in care.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Abigail Martinez Gonzalez. A final decision of License issuance will be determined by the department unit licensing Manager.

Licensee 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 Abigail Martinez Gonzalez 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 [facility representative] 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.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 3 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 GONZALEZ & SANTACRUZ FAMILY CHLD CARE
FACILITY NUMBER: 197494753
VISIT DATE: 09/17/2021
NARRATIVE
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Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care 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

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.


Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be must be kept current, as well as the roster and Drill Log additional forms can be obtained from Maintained At The Facility - Family Child Care Home. Applicant was reminded that all documents for children's records the Department website: www.ccld.ca.gov

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 4 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 GONZALEZ & SANTACRUZ FAMILY CHLD CARE
FACILITY NUMBER: 197494753
VISIT DATE: 09/17/2021
NARRATIVE
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FORMS TO BE POSTED
· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster
Children’s records requirements:
· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· Immunization record
· PUB 72- Family Child Care Consumer Guide
· LIC 995A Notification of Parent’s Rights
· CDPH 286 (Immunization Blue Card)
FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Landlord Consent Form, if you plan to care for more than 6 children for a Small
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates

· Copy of your deed or lease/rental agreement


· Documentation of Fire and Disaster drills
· Proof of immunization's against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandated reporterca.com – renewed every two years.


SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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 GONZALEZ & SANTACRUZ FAMILY CHLD CARE
FACILITY NUMBER: 197494753
VISIT DATE: 09/17/2021
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·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. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
·Telephone number changes and/or if you move from home
·Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference
·Fire and safety drills must be performed every six months and documented for review by the Department. (Child care Fire Drill log provided to applicant)
·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.
·LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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