376100043-7-8-2019-51-CC-RGOU-BDVMEG-20190708093244

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100043
Report Date: 07/08/2019
Date Signed: 07/08/2019 09:32:51 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:	MARTINS, JASON FAMILY CHILD CARE		FACILITY NUMBER:	376100043
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	07/08/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:24 AM
MET WITH:	Jason Martins		TIME COMPLETED:	09:50 AM

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) Rajani Goudreau conducted an announced Pre-Licensing inspection for a change of location with licensee Jason Martins. Business hours are: Monday through Friday from 7:00 a.m. to 6:00 p.m. This one story 3-bedroom and 2-bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during inspection. There are no firearms or other weapons in the home, per Licensee. Pediatric CPR and First Aid certification expire on June 2021. Preventative Health Practices course has been completed, verification on file. Fireplace is screened and located in off limit area of the home. Primary telephone is a cell which is operational. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee rents the facility and has provided proof of control of property by a rental agreement. Licensee states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. Licensee has met immunization requirement per SB792. Licensee is exempt from the AB1207 Mandated Reported Training as primary language is not English. Licensee will use the following areas for child care: playroom, bathroom located in hallway of home, nap room and back yard. Off limits areas of the home include: office room, master bedroom, master bathroom, kitchen, family room and garage. All off limit areas of the home are made inaccessible.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

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: MARTINS, JASON FAMILY CHILD CARE	FACILITY NUMBER: 376100043
	VISIT DATE: 07/08/2019

NARRATIVE

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LPA discussed and provided Licensee with the following: information on SIDS, shaken baby syndrome, lead poisoning effects brochure, Heart and Nutrition Months hand out, insurance, child abuse reporting, mandated reporter requirements, community resources, children’s records/facility records/required postings-LIC911D, immunization requirements, unusual incident report-LIC624B, roster requirements-LIC9040, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), emergency drill log example, and the YMCA Resource Center.

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 provided 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 discussed with licensee California Megan's Law and LPA provided: www.meganslaw.ca.gov. To access Child Care Licensing Regulations and Forms visit the following website: http://ccld.ca.gov. LPA discussed and provided licensee with the following: Child Care Advocates - (916) 654-1541 and email address childcareadvocatesprogram@dss.ca.gov.In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

Large: LPA discussed the following with Licensee: Max capacity when there is an assistant present: 12 children-no more than 4 infants (birth to 24 months). When caring for 14 children no more than 3 infants. 1 child in kindergarten and 1 child at least 6 years old. When there is no qualified assistant the capacity reverts back to the requirements from a small child care. You must notify the parents of the children in care when caring for more than 12 children.

The facility is ready to be licensed after final file review. After final file review, License will be mailed to licensee. LPA informed licensee upon receipt of the license, the license shall be posted it in a prominent place.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

LIC809 (FAS) - (06/04)

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