376619037-12-11-2019-20-CC-CGUY-BJRPQZ-20191211103158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376619037
Report Date: 12/11/2019
Date Signed: 12/11/2019 10:32:05 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, SUSANA FAMILY CHILD CARE		FACILITY NUMBER:	376619037
ADMINISTRATOR:	SUSANA MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 347-0402
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY:	14	CENSUS: 12	DATE:	12/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Susana Martinez, Licensee		TIME COMPLETED:	10:40 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 Analysts (LPAs) Casey Gulley and Michelle Hood, made an unannounced annual/random inspection. Upon arrival LPAs met with Licensee and proceeded to tour the facility. During this inspection there were 12 children in care with one helper. The facility is within licensed capacity/ratio limitations. Licensee stated there are no new adults living in the home over the age of 18 years. A review of staff records on 12/11/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Licensee has CPR/first aid certifications valid through 7/30/21. The last fire and disaster drills were conducted and documented on 9/3/2019. Offlimit areas made inaccessible to day care children through the use of safety gates and latches. No bodies of water were observed during time of inspection. There is a working fire extinguisher rated 3A 40B:C, smoke and carbon monoxide detector are present and operational. LPAs reviewed a sample of Children’s Records, licensee maintains the Notification of Parents’ Rights and Immunization Records as required. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children through the use of cabinet latches and/or placed in off limit areas. Adequate heating and ventilation is provided for day-care children. Children’s toys, play equipment and materials are available. Licensee states there are NO firearms or weapons in the home. Licensee maintains a current facility roster of the children which LPAs obtained during time of inspection. LPAs reviewed the following with licensee: SIDS, car seat law, reporting requirements and shaken baby syndrome. Licensee revised and updated facility personnel report to confirm all adult residents/helpers associated to the facility. LPAs advised licensee that any new/additional adults must be cleared prior to working or residing in home. Any minor upon his/her 18^th birthday must be fingerprinted within 30 days. Licensee was also reminded the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey Gulley	TELEPHONE: (619) 767-2248
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

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, SUSANA FAMILY CHILD CARE	FACILITY NUMBER: 376619037
	VISIT DATE: 12/11/2019

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Licensee states she does not provide IMS to clients at this time. 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.html

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

LPAs and Licensee discussed, Safe Sleep, Effects of Lead Exposure and California Megan's Law, LPAs provided: www.meganslaw.ca.gov.

Licensee will request to be on the distribution list for child care updates. Go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and click “subscribe.”

LPAs reviewed this report with licensee and an exit interview was conducted. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their 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. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey Gulley	TELEPHONE: (619) 767-2248
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

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