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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334809388
Report Date: 06/24/2021
Date Signed: 06/24/2021 04:54:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
334809388
ADMINISTRATOR:MARTINEZ, NADEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 733-9098
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY:14CENSUS: 10DATE:
06/24/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:27 PM
MET WITH:Nadeen Martinez, LicenseeTIME COMPLETED:
04:56 PM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on March 10, 2021. It indicates the Licensee received a call from Corona Police Department alleging an incident occurred at the facility seven years ago involving a child who is no longer enrolled and a minor child. The Unusual Incident Report was followed up by Investigator Brittany Hudec. Interviews were conducted and pertinent documentation was obtained.

Based on information gathered, the facility acted appropriately and no violations have been identified. The Licensee immediately reported the alleged incident to Licensing and an
LIC 624 was submitted within seven days.

An exit interview was conducted and a copy of this report was provided to facility staff. A Notice of Site Visit was provided and must be posted for 30 days.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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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