372015017-12-19-2019-51-CC-GCUS-BJZMP3-20191219084627

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372015017
Report Date: 12/03/2019
Date Signed: 12/19/2019 08:46:37 AM

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: 8	DATE:	12/03/2019
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Anna Martinez		TIME COMPLETED:	03:30 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 conducted an unannounced Case Management-Annual Continuation Inspection with Licensee Anna Martinez. Also present was the Licensee’s helper Judith Morales Servin. During this inspection there were 8 children present, 3 of whom were under 24 months. The facility is within licensed capacity/ratio limitations. The purpose of today’s inspection is to inform the Licensee of the results of the facility file review that was conducted as a result of there being an uncleared adult in the facility at the time of LPA Leilani Curtis’s Annual Inspection dated 11/22/19. During the 11/22/19 inspection the Licensee stated that her daughter Sarah Cowell (formally Martinez) comes to the home/facility 2-3 times a month for work and will stay one-two nights and then return home. After a thorough review of the facility file it was determined that the Licensee, Anna Martinez requested that her daughter Sarah Martinez (now Sarah Cowell) be dis-associated from the facility on 10/06/04. As recently as 11/13/18 the Licensee confirmed all cleared staff and/or residents associated to the facility. Sarah Cowell was not on the association list nor did the Licensee request for her to be added to the list. The Licensee failed to make sure that all adults who have a prominent presence in the home obtain and maintain a California clearance or a criminal record exemption as required by the Department. See LIC809D for cited deficiency. A civil penalty has been assessed. The LPA reviewed and provided a copy of the Licensee’s appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

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: 12/03/2019

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Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

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”.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/06/2019 Section Cited	1 2 3 4 5 6 7	Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on Licensee's statement and LPA's facility file review the Licensee's uncleared adult daughter, Sarah Cowell was present during LPA's 11/22/19 inspection. Per Licensee her daughter resides overnight in the home/facility 2-3 times a month. Her daughter will stay 1-2 nights when she visits. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
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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: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

LIC809 (FAS) - (06/04)

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