<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614462
Report Date: 06/11/2019
Date Signed: 06/11/2019 01:21:04 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:CORDOVA, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
376614462
ADMINISTRATOR:CORDOVA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 662-2370
CITY:SAN YSIDROSTATE: CAZIP CODE:
92173
CAPACITY:14CENSUS: 5DATE:
06/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Martha CordovaTIME COMPLETED:
01:30 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) Yolanda Baez arrived at the facility to conduct an annual random continuation. LPA Baez met with Licensee, Martha Cordova. There were 5 day care children in care at the time of the inspection.

LPA toured the home, this is a one story, 4 bedrooms and 2 bathrooms home. The primary child care areas are the following: dining room area, one hallway bathroom, kitchen, living room, all 4 bedrooms, bathroom #2, and the back yard. The following areas are kept inaccessible with the use of locks or safety gates: the attached garage. There are a sufficient amount of age appropriate toys, games, and books available. The home has plenty of space for the children to eat, sleep and play, and was a comfortable temperature during this visit. The back yard is fully fenced and used for outdoor activities. The fire extinguisher is full, of regulation size, and located near the kitchen. There is no fireplace on the property. The smoke alarm and carbon monoxide monitor are operational. LPA Baez verified a working telephone and all required forms are posted. There are no large bodies of water on the property. Licensee stated that there are no firearms or ammunition on the property. LPA Baez verified that all adults living or working in the home have been fingerprint cleared and associated. LPA Baez reviewed children's files, child care roster, and emergency drill log. Licensee's pediatric CPR/FA certification expires on 05/2020.

LPA Baez reviewed the following with Licensee: physical plant, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, new Safe Sleep Regulations, emergency drills, child care roster, and Unusual Incident Reports. LPA reminded Licensee that walkers, jumpers, exersaucers, and bouncers are not permitted for use in the day care. Licensee was provided with the Spanish PIN 19-05-CCP. Licensing fees page was given to Licensee and discussed.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CORDOVA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376614462
VISIT DATE: 06/11/2019
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
26
27
28
29
30
31
32
IMS was discussed. Licensee is not currently providing IMS, Licensee understands that a written plan of operation must be submitted prior to enrolling a child that requires IMS. 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 http://www.ada.gov/childqanda.htm

Immunization law (SB792) was discussed with Helper. Helper understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Licensee is compliant with SB792.

LPA Baez discussed the new Mandated Reporter training (AB1207) with Helper and Helper understands that herself and her helpers will need to take the training and keep the certificate present at the facility for review. Licensee is compliant with AB1207.

LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.



There were not any deficiencies issued throughout today's inspection. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.
Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov
Duty Line: (619) 767-2248, Open Monday thru Friday 8am - 5pm
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2