376619037-7-20-2021-20-CC-DSTS-C54UU3-20210720155251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376619037
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:53:04 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:	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: 8	DATE:	07/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:	Susana Martinez		TIME COMPLETED:	03:00 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	On July 20, 2021 at 01:39 PM, Licensing Program Analyst (LPA),Dana Stevens conducted an unannounced Annual Required Inspection and met with the Licensee, Susana Martinez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Eight children (ages 4,4,4,3,2,6 months,14 months, 23 months) and Licensee's assistant were present in the facility during this inspection. This facility is a single story, 5 bedroom, 4 and half bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: daycare room, kitchen, living room, and half bathroom. Off limits areas are all bedrooms, 4 bathrooms, dining room and detached garage. These areas are inaccessible through use of door locks and safety gates. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The storage area for poisons is locked. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. 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’s First Aid/CPR certifications expire 07/2021. Assistant's First Aid/CPR certification expires 09/2021. Licensee has required immunization. Assistant's proof of immunization were not available. Licensee completed Mandated Reporter Training in August 2020 and assistant completed Mandated Reporter Training in April 2018. Facility roster was reviewed and was found current. The last fire and disaster drills were conducted and documented on 06/2021.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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: 07/20/2021

NARRATIVE

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There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider is not physically checking on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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: 07/20/2021

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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

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/20/2021 Section Cited	1 2 3 4 5 6 7	1597.622(a)(1) Employees or volunteers at family day care home; immunization requirements... Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles... This requirement was not met as evidenced by,
	8 9 10 11 12 13 14	Based on LPA observation and record review Licensee did not have proof of assistant's immunizations, which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
Type B 08/20/2021 Section Cited	1 2 3 4 5 6 7	The provider shall supervise infants while they are sleeping...The provider shall physically check on the infant every 15 minutes...Documentation shall include the following...Date...Infant's name...Time... This requirement was not met as evidenced by,
	8 9 10 11 12 13 14	Based on LPA's obsesrvation, record review, and Licensee's admission, she was not maintaining sleep logs for the infants in her care.	8 9 10 11 12 13 14

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: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC809 (FAS) - (06/04)

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