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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019677
Report Date: 03/01/2021
Date Signed: 03/01/2021 12:09:54 PM

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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198019677
ADMINISTRATOR:LORENA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 427-4708
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:14CENSUS: 4DATE:
03/01/2021
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Lorena Martinez, Licensee TIME COMPLETED:
11:35 AM
NARRATIVE
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Due to COVID-19 and precautionary measures this inspection was conducted via Face Time. This inspection was conducted in English and in Spanish.

Licensing Program Analyst (LPA) Rita Ramos conducted an announced tele-visit on 03/01/21 at 10:35 AM and met with Licensee, Lorena Martinez. There were 4 children present during the inspection.

The purpose of the inspection was to address Licensee’s own written and signed letters and declarations to the Department.

Licensee submitted a letter in which she indicated that Child #1 gave Child #4 medication while under Licensee’s care and supervision.

Licensee also wrote in a letter that she observed Adult #1 violate Child #3’s personal rights and did not report the incident to the Department.

Licensee submitted a written declaration indicating that Licensee’s mother, Maria Cardenas, assists Licensee in caring for children. Parent #1 stated that Licensee told Parent #1 that Licensee gets help from Licensee’s mother. Parent #2 stated that Licensee’s mother is the assistant. Parent #5 disclosed that they have seen Licensee’s mother at the facility. Licensee’s mother, Maria Cardenas, is not associated to the facility. Per Licensee, their mother Maria Cardenas does not have a criminal record clearance. A civil penalty of $100 is being assessed.

In addition, Child #1 and Child #2 both disclosed that Licensee allows children to play in the backyard. Parent #4 disclosed that they observed children playing in the backyard. The backyard is an off-limits area in which the Licensee submitted a written declaration prior to being licensed indicating that children will not be permitted to play in the back yard.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2021
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 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019677
VISIT DATE: 03/01/2021
NARRATIVE
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Therefore, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

An exit interview was conducted by LPA Rita Ramos with Lorena Martinez, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. This report was sent via email to Licensee and an electronic read receipt confirms receiving the report. The Licensee was provided with the Monterey Park South West office and agrees to send the signed originals by mail.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019677
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/01/2021
Section Cited

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:Obtain a California clearance or a criminal record exemption as required by the Department
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This requirement is not met as evidenced by Parent #1, #2, and #5 providing information that Licensee’s mother, Maria Cardenas, assists Licensee in providing child care. This poses an immediate health and safety risk to children in care. A civil penalty of $100 is being assessed.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019677
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2021
Section Cited

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Alterations to Existing Buildings or Grounds

Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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This requirement is not met as evidenced by Child #1, Child #2, and Parent #4 disclosing that Licensee allows children to play in the backyard. This poses a potential health and safety risk to children in care.
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Type B
03/15/2021
Section Cited

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Reporting Requirements

In addition to the events specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C), the licensee shall report the following events to the Department: Any suspected child abuse or neglect…
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This requirement is not met as evidenced by Licensee failing to report that they observed Adult #1 violate Child #3’s personal rights. This poses a potential health and safety risk to children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2021
LIC809 (FAS) - (06/04)
Page: 4 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019677
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2021
Section Cited

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Operation of a Family Child Care Home

The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
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This requirement is not met as evidenced by Licensee’s own written declaration that Child #1 gave Child #4 medication while children were under the care of Licensee. Due to Child #1 and Child #4 no longer attending the facility, this poses a potential health and safety risk to children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5