372015017-11-22-2019-51-CC-GCUS-BJ72M9-20191122163047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372015017
Report Date: 11/22/2019
Date Signed: 11/22/2019 04:30:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MARTINEZ, ANNA FAMILY CHILD CARE		FACILITY NUMBER:	372015017
ADMINISTRATOR:	ANNA MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 455-7501
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92122
CAPACITY:	14	CENSUS: 9	DATE:	11/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Anna Martinez		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Leilani Curtis made an unannounced Annual Random inspection and met with Licensee, Anna Martinez. Also present was the Licensee’s helper Gladis Urquiza Quevedo and the Licensee’s adult daughter Sarah Cowell. Samuel Martinez, the Licensee’s husband arrived at the facility at 3:10 p.m. There were 9 children in care, 4 who were infants. Facility was observed operating within ratio and capacity. LPA conducted a tour of the home inside and outside per facility sketch. Licensee is using the following areas for daycare: living room, kitchen, dining area, family room/daycare room, bathroom and enclosed rear yard. Off-limits areas include: entire upstairs, bedroom #1 and garage. Business Hours: Monday-Friday; 7:00 a.m.-5:30 p.m. Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. Stairs are barricaded. There is a working telephone/email address. All cleaning compounds, detergents, medications, and poisons are made inaccessible through latches, locks, and/or placed up on high surfaces. Fireplace is screened. The fire extinguisher, carbon monoxide and smoke detectors are operational. Licensee states there are NO firearms or other weapons in the home. Outdoor play area is fenced and free of hazardous items. There are no existing bodies of water present. Children records were reviewed for Emergency Information. During today’s inspection the Licensee stated that her adult daughter Sarah Cowell was present in the facility and asleep in the downstairs bedroom (bedroom #1). The Licensee also stated that her daughter came in last night, 11/21/19 and comes down 2-3 times a month for work. She will stay 1-2 nights and then return to her home. Sarah Cowell is not cleared or associated to the facility. The Licensee states that her daughter was cleared and associated at one time and she does not know why her daughter was removed from the facility. She states that she never requested that her daughter be removed from her facility. The Licensee was advised that LPA will review her facility file to determine why her daughter was removed from her facility.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, ANNA FAMILY CHILD CARE	FACILITY NUMBER: 372015017
	VISIT DATE: 11/22/2019

NARRATIVE

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Licensee was advised that if her daughter continues to have a prominent presence in the home she must be fingerprint cleared and associated to the facility. The Licensee states that she will have her daughter re-fingerprinted. All other adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Pediatric CPR and First-Aid certificates are valid through 2/2021 for Anna Martinez and 3/2021 for helper Gladis Urquiza Quevedo. Licensee and staff have completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certification and it is in compliance. Immunization records per SB792 were also reviewed and they are in compliance.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed the following with Licensee: Safe Sleep Regulation Concept Handout, Car Seat Law, SIDS, Effects of Lead Exposure and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee is aware that interference with a child’s daily functions, corporal punishment, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

No deficiencies observed in the areas inspected during today's inspection. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit. LPA reviewed this report with Licensee prior to obtaining her signature.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.
Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

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