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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019677
Report Date: 03/01/2021
Date Signed: 03/01/2021 11:17:03 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2020 and conducted by Evaluator Rita Ramos
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20201211132450
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
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Lorena Martinez TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee treated day care child differently than other children in care
Licensee did not feed day care child
Licensee denied day care child water
Day care child sustained unexplained injuries
INVESTIGATION FINDINGS:
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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 complaint inspection on 03/01/21 at 9:05AM to deliver findings for the above allegations. LPA met with Licensee, Lorena Martinez, who guided LPA on tele-tour of the facility. There were 4 children present during the inspection.

During the investigation LPA obtained a copy of the facility roster, documentation, and conducted interviews.

Information provided by the reporting party indicates that Licensee treated Child #5 differently than the other children, Licensee did not feed or provide water to Child #5, and that Child #5 sustained unexplained injuries.

Licensee was interviewed during the course of the investigation. ----Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 54-CC-20201211132450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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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Parents interviewed did not make any disclosures regarding the above allegations.

Children interviewed did not make any disclosures regarding the above allegations

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

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.

----Page 1 of 2

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
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2020 and conducted by Evaluator Rita Ramos
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20201211132450

FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198019677
ADMINISTRATOR:LORENA MARTINEZFACILITY TYPE:
810
ADDRESS:3701 PALOMA STTELEPHONE:
(323) 427-4708
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:14CENSUS: 4DATE:
03/01/2021
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Lorena Martinez TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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5
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9
Licensee inappropriately disciplined day care child
INVESTIGATION FINDINGS:
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13
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 complaint inspection on 03/01/21 at 9:05AM to deliver findings for the above allegations. LPA met with Licensee, Lorena Martinez, who guided LPA on tele-tour of the facility. There were 4 children present during the inspection.

During the investigation LPA obtained a copy of the facility roster, documentation, and conducted interviews.

Information provided by the reporting party indicates that Licensee inappropriately disciplined day care child.

Licensee was interviewed during the course of the investigation. ----Page 1 of 2
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 54-CC-20201211132450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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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Parent #3 disclosed that Licensee pushed Child #6 when Child #6 was in care.

When interviewing children, Child #1 disclosed that Licensee yells and puts children in a corner as a form of discipline.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 102423(a)(4), is being cited on the attached deficiencies page.

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.

------Page 1 of 2

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
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 54-CC-20201211132450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
CCR
102423(a)(4)
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Personal Rights

To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...
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Per Licensee, a written declaration indicating that Licensee will not inappropriately discipline children will be submitted by POC due date of 03/15/21. Licensee states that they will go to a resource and referral agency to obtain resources and information on how to appropriately discipline children.
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This requirement is not met as evidenced by Parent #3 disclosing that Licensee pushed Child #6 and Child #1 disclosing that Licensee yells and places children in a corner as a form of discipline. Due to Licensee not caring for all children previously enrolled, 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
LIC9099 (FAS) - (06/04)
Page: 5 of 5