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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628570
Report Date: 05/04/2022
Date Signed: 05/04/2022 10:30:13 AM


Document Has Been Signed on 05/04/2022 10:30 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: 5DATE:
05/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:18 AM
MET WITH:Elvia MartinezTIME COMPLETED:
09:30 AM
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On May 4th, 2022 at 8:18 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced case management inspection to amend reports issued on 04/18/2022. LPA advised Licensee Elvia Martinez of the inspection’s purpose and she granted LPA facility entry. Language Link Operator 14686 provided Spanish translation. Present in the home was the Licensee, a staff member, five (5) daycare toddlers (ages 2 - 5 years).

The prior LIC 9099 and LIC 809 reports, dated 04/18/2022, referenced there were ten (10) children with staff on the afternoon of 03/18/2022. The corrected reports reflect staff was left with eleven (11) total children while the Licensee was gone conducting child transportations.

The prior and corrected reports were reviewed by the Licensee and LPA. Staff signed the corrected report and was provided with copies of the corrected reports.

A notice of site visit was given and must remain posted for 30 days. Licensee/Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to Licensee 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: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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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