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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628570
Report Date: 03/24/2022
Date Signed: 03/24/2022 11:55:08 AM


Document Has Been Signed on 03/24/2022 11:55 AM - It Cannot Be Edited

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, ELVIA FAMILY CHILD CAREFACILITY NUMBER:
376628570
ADMINISTRATOR:ELVIA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 653-9129
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:14CENSUS: 1DATE:
03/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Elvia MartinezTIME COMPLETED:
09:51 AM
NARRATIVE
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On March 24th, 2022 at 8:20 AM, Licensing Program Analysts (LPA) Gloria Gonzalez and Jo Ann Legaspi conducted a case management inspection regarding an issue detected during a complaint inspection. LPAs advised Licensee Elvia Martinez of the inspection's purpose and she granted LPAs with facility entry. Present in the home was the Licensee and one (1) toddler (2 - 5 years). LPA Gonzalez provided Spanish translation services.

LPAs interviewed the Licensee. On 03/18/2022, Child 1 (C1) eloped from the home but was returned by law enforcement. (See LIC 811 Confidential Names) C1 was found about 1.5 blocks away from the facility by law enforcement. Review of the Community Care Licensing (CCL) records reveals no incident report was filed with CCL regarding this incident. The Licensee stated this incident was not reported to the Department because she is still in shock about the incident.

Based on conducted interviews and a file review, it has been determined that the facility failed to report the aforementioned unusual incident to CCL. This deficiency is being cited per the California Code of Regulations, (Title 22, Division 6), and described on the attached LIC 809D.



A notice of site visit was given and must remain posted for 30 days. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to Elvia Martinez. Exit interview conducted and report was reviewed with the licensee Elvia Martinez.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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Document Has Been Signed on 03/24/2022 11:55 AM - It Cannot Be Edited

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, ELVIA FAMILY CHILD CARE
FACILITY NUMBER: 376628570

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2022
Section Cited

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Reporting Requirements - " ... The licensee shall report to the Department … Any child absence…any child in care who wanders away from the Family Child Care Home…shall be reported even if the child is later found safe ... " This requirement was not met as evidenced by:
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Licensee did not report the 3/18/22 incident where C1 was found outside unsupervised by staff. Based on staffs' admission & record review, licensee did not report the 3/18/22 incident, which poses as a potential health & safety risk to children in care.
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This training is at
https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/
LPA gave Lic. a hard copy of CCR 102416.2. The Lic. agrees to give LPA a written statement describing which incidents will be reported to CCL and when the verbal report will be made.

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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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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