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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003331
Report Date: 10/11/2023
Date Signed: 10/11/2023 05:35:29 PM


Document Has Been Signed on 10/11/2023 05:35 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198003331
ADMINISTRATOR:MARTINEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 913-6447
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 3DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Maria MartinezTIME COMPLETED:
05:35 PM
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Visit conducted in Spanish

On 10/11/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced annual inspection for the above facility. Covid risk assessment was conducted. LPA met with Licensee, Maria Martinez and her spouse Hugo Martinez. LPA observed 3 children in care. A children’s facility roster was available. Per Licensee, operating hours are from Monday - Sunday 4:00 am – 11:30 pm and cares for children ages 4 months to 13 years of age. The licensee provides breakfast, AM/PM snack, lunch and dinner to the children in care and licensee provides meals.

This is a one-story home which consists of a living room, kitchen, dining room, family room, garage. front yard, back yard, side yard, 3 bedrooms and 2 1/2 bathrooms. Areas used by the children are family room, dining room, back yard and 1 bathroom. Per Licensee, areas off limits to children and parents include 3 bedrooms, kitchen, living room, front yard, side yard, 1 bathroom, and ½ bathroom.

The licensee states that 4 adults currently live in the home. Per Licensee, they currently have 1 adult who assist as they operate a large facility. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed childcare home. 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.

Licensee states that there are no firearms stored in the home. LPA observed a baby gate between the kitchen and family/dining room.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003331
VISIT DATE: 10/11/2023
NARRATIVE
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The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service.
Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee conducted an Earthquake Drill in July 2023. No one smokes in the at family childcare home.

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 Pediatric First Aid and CPR training, Immunization's (TDAP, MMR, TB, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.



Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection.

LPA observed the required 2:A-10:B-C fire extinguisher and per Licensee it had been serviced on August 30, 2023. Per State Fire Marshall standards, fire extinguishers shall be service annually. The smoke detector and carbon monoxide detector were working properly. Per Licensee, there are no weapons, firearms, or bodies of water on the premises. There is currently 1 dog. Dog is kept locked up away from children in the living room behind a gate which is an off limit area when children are present.

LPA advised the Licensee with regards to safe sleep and that infants under 24 months shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name, date and initials of the person who checked on the child. LPA provided Licensee a booklet on Safe Sleep. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. LPA advised Licensee the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect. Per Licensee children are checked but is not documenting the 15-minute sleep check. LPA provided a sample sheet and Licensee will be begin checking tomorrow, October 12, 2023.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats. The Licensee was reminded to utilize play yards, cribs and highchairs for what they are intended for and not leave children in them for any other reason.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003331
VISIT DATE: 10/11/2023
NARRATIVE
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee, her spouse and assistant currently have Pediatric First Aid and CPR which expires on 9/2025, which includes the EMSA sticker. There are first aid supplies available. Licensee, spouse, and assistant currently have the mandated reporting training certificate AB 1207, which expired August 2023. LPA advised that Mandated Reporting training needs to be conducted every 2 years.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be enclosed with a concrete wall and chain link fence. LPA observed that the outdoor yard has toys, bikes, basketball hoop, and play structure and other materials for children to play with.



Children and Staff records must be maintained and updated as needed and must be available for review by the Department. If Children and Staff leave the day care all records must be maintained for 3 years after leaving.


To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA discussed the safe sleep regulations with licensee 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 [or 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003331
VISIT DATE: 10/11/2023
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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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Please see LIC809-D pages for deficiency cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1.

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

Exit interview conducted and report was reviewed with the Licensee, Maria Martinez.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/11/2023 05:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003331

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews, the licensee did not comply with the section cited above in licensee was observing but not documenting the 15 mintue sleep log for infants under 2 years old which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/12/2023
Plan of Correction
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Per Licensee she will begin documenting 15 minute log. Licensee will email a copy.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in licensee, assistant and spouse have expired mandated reporting training certificates which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2023
Plan of Correction
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Per Licensee will submit copies of Certificates and email to LPA.
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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
LIC809 (FAS) - (06/04)
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