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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334809551
Report Date: 12/16/2020
Date Signed: 12/16/2020 04:38:30 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:MARTHA'S VILLAGE & KITCHENFACILITY NUMBER:
334809551
ADMINISTRATOR:ROSA VERDUZCOFACILITY TYPE:
830
ADDRESS:83-791 DATE AVENUETELEPHONE:
(760) 347-4741
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY:23CENSUS: 4DATE:
12/16/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Beltran Quintero, Director TIME COMPLETED:
11:00 AM
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December 16, 2020 Due to COVID-19, Licensing Program Analyst (LPA) Sharleen Robinson conducted a Tele-inspection with Director Maria Beltran Quintero, for another purpose. The Director self reported the following unusual incident:

On or about December 15, 2020 A child was dropped off at the facility by their representative, the child was dropped off at approximately 9:10am wearing a mask that covered their nose and mouth. A staff member was assisting another child who was crying. At approximately 9:20am the staff member pulled down the child's mask to perform a health check. The staff member discovered the child had a runny nose (green mucus) and the left side of the child’s lower lip was red and injured, (the skin was not broken). At approximately 9:30am the staff member notified the child’s representative. The representative arrived to pick up the child at approximately 9:45am. Per the staff member, the representative stated the child’s lip was not red or injured prior to the child arriving at the facility. The Director was notified, she conducted interviews with staff and made observations.

LPA Robinson conducted interviews and made observations. LPA Learned when the incident occurred there was one staff member caring for four toddlers. It is facility policy for staff to perform health checks on children when they arrive. Staff document findings of health checks and notify parents if need be. The child(ren) were unavailable to participate in the interview. No medical attention sought for the child. Based on the information obtained during the visit, there appeared to be no violation of Title 22 Regulations pertaining to the reported incident.

No deficiencies sited at this time. An exit interview was conducted via Zoom, LPA Robinson provided the Director with a copy of this report via email, LPA asked the Director to acknowledge receipt of the email. An electronic “read receipt” was also attached. The electronic read receipt of the emailed report acknowledges receipt of this report. A copy of this report and Notice of Site Visit was emailed to the Director during this Tele-inspection on December 16, 2020. A copy of this report must be made available for the next three years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 233-7183
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
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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