198019677-3-29-2021-54-CC-BVON-C2BL89-20210422083136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019677
Report Date: 03/29/2021
Date Signed: 03/29/2021 11:09:49 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
10/14/2020 and conducted by Evaluator Rita Ramos

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20201014113950

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019677
ADMINISTRATOR:	LORENA MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 427-4708
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90011
CAPACITY:	14	CENSUS: 4	DATE:	03/29/2021
		ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Lorena Martinez, Licensee		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Day care child sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

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THIS INSPECTION WAS CONDUCTED IN SPANISH AND ENGLISH
Due to COVID-19 and guidelines of social distancing, this inspection was conducted virtually via FaceTime. Licensing Program Analyst (LPA) Rita Ramos met with Lorena Martinez, Licensee, who guided analyst on a tour of the facility. There were 4 children present.

The purpose of the inspection was to deliver findings for the above allegation.

The investigation for the above allegation was conducted by the Department’s Investigation Bureau. During investigation interviews were conducted, a copy of the children's roster and other supporting documentation was reviewed and obtained.

Information provided by the reporting party indicates that Child #1 sustained injuries while under the direct care and supervision of the Licensee. -----Page 1 of 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20201014113950

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: 03/29/2021

NARRATIVE

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Based on the investigation conducted by the Department’s Investigation Bureau and interviews which were conducted and record reviews, 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 102417(a) Operation of a Family Child Care Home, is being cited on the attached deficiencies page.

Due to Licensee being cited on 01/25/21 and also on 03/01/21 for the same deficiency, a civil penalty of $250 is being assessed for a repeat violation.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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 Applicant and an electronic read receipt confirms receiving the report. The representative was provided with the Monterey Park South West office address and agrees to send the signed originals by mail.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 54-CC-20201014113950

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: 03/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/30/2021 Section Cited CCR 102417(a)	1 2 3 4 5 6 7	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. This requirement is not met as evidenced by the Department's investigation Bureau	1 2 3 4 5 6 7	Per Licensee, daily wellness checks will be conducted upon parents picking up and dropping off children. Licensee will ask parents to sign and confirm the wellness check upon pick up and drop off. Licensee will also purchase cameras for future installation and added security.
	8 9 10 11 12 13 14	conducting interviews, record reviews, and obtaining supporting documentation that Child #1 sustained unexplained injuries while in care. This poses an immediate health and safety risk to children in care. This is a repeat violation, therefore, a $250 civil penalty in being assessed.	8 9 10 11 12 13 14	Pictures of the wellness check logs and the security cameras will be submitted by POC due date of 03/30/21.
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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 VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

LIC9099 (FAS) - (06/04)

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