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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415895
Report Date: 05/22/2023
Date Signed: 05/23/2023 04:46:52 PM


Document Has Been Signed on 05/23/2023 04:46 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MARTINEZ, JOSE & AYALA, VIRIDIANAFACILITY NUMBER:
274415895
ADMINISTRATOR:JOSE & VIRIDIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 406-2358
CITY:ROYAL OAKSTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 5DATE:
05/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Virdiana AyalaTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA) Elizabeth Berumen conducted an unannounced 1 year required inspection to the home today. LPA met with Licensee, Viridiana Ayala and explained the nature of today's inspection to her. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The adults residing in the home are licensees', Jose Martinez, Viridiana Ayala, their adult daughter, Casey Martinez and son Jose Martinez Jr. LPA observed two infants, two pre-schoolers, one school age child. Licensee's daughter, Casey Martinez is her assistant. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the day care.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on February 14, 2023. Licensee has day care insurance. Licensee has current CPR and First Aid certifications which are valid through April 5, 2024. Licensee has the required vaccines (MMR, Tdap, & influenza) and is current with her Mandated Reporter Training for Child Care Workers (exp: May 5, 2024). LPA reviewed five children's files and the files were complete with the required forms. LPA reviewed three staff file (Licensee, Viridiana Ayala, Jose Martinez, and Casey Martinez) and the files are complete with the required forms. Licensee states that a sick child will be isolated in the living room.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA notes that the home is divided into three living quarters; Licensee lives in the middle home. Tenants; Serafin Bejarano, Anjelica Jimenez and 4 minor children live on the right side; Leticia Ruvalcaba and Gabriela Mata and two minors live in the front of home. All residents have TB test and fingerprint clearances. Licensee has a working telephone in the home. The home is clean, orderly, and safe for the children. There are safe and age appropriate toys, play equipment, and materials for the children in the home. LPA observed a barricaded wall heater in the hall way. The following rooms are off limits: 3 bedrooms, and area where tenants reside.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MARTINEZ, JOSE & AYALA, VIRIDIANA
FACILITY NUMBER: 274415895
VISIT DATE: 05/22/2023
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The outdoor area that is in the back of the home is off limits; sliding door leading to that area is locked today. Previously there were three storage sheds; there is one storage shed in the off limit area and one that was moved up to the upper yard area. LPA recommends Licensee to place the wood cubbie to barricade the sliding door or install an alarm. Licensee uses the front fenced area (drive way) of the home for outdoor play space for children. The area is fenced and safe for children. LPA notes that the property is elevated and the yard area where the turkey, chickens and two emu's are kept are off limits to children.
LPA observed a fully charged 3A40BC fire extinguisher that was last serviced on April 18, 2023. The smoke/carbon monoxide detectors were tested and proved to be functioning. No bodies of water were observed. The Licensee states that she does not have any weapons. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. Any poisons are locked and inaccessible to the day care children. There are pets on the property that belong to the landlord that are kept in the off limit area of the property. LPA observed chickens, a turkey and an two Emu's in gated area away from the children play area.

Licensee states that they provide all the meals and snacks to the day care children. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee understands that smoking is prohibited in the home. Licensee states that she does administer medications to the day care children when needed and understands the Incidental Medical Service requirements.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options. Licensee states that does transport day care children on an as needed basis. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MARTINEZ, JOSE & AYALA, VIRIDIANA
FACILITY NUMBER: 274415895
VISIT DATE: 05/22/2023
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Exit interview conducted and report was reviewed with the Licensee, Viridiana Ayala. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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