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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505839
Report Date: 05/09/2022
Date Signed: 05/09/2022 12:11:15 PM


Document Has Been Signed on 05/09/2022 12:11 PM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MARTINEZ, MARIA E.FACILITY NUMBER:
380505839
ADMINISTRATOR:MARTINEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 586-0461
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:12CENSUS: 6DATE:
05/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria MartinezTIME COMPLETED:
12:10 PM
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On May 9, 2022, Hanson Leong, a Licensing Program Analyst (LPA), conducted an unannounced annual inspection with Maria Martinez. LPA explained the purpose of the visit to the licensee. All staff members at the facility have criminal background checks on file. The LPA observed one assistant, including the licensee, supervising six children. From Monday to Friday, the hours of operation are 7:30 am. to 5:30 pm.

The daycare areas include a playroom, two nap rooms, bathroom, kitchen, and backyard. The entire upper level is off-limits. When a child exhibits symptom of illness, the Licensee will separate the child while contacting the parent to arrange for the child's pick-up

LPA and the Licensee thoroughly checked the daycare areas for potential health and safety hazards. The daycare is outfitted with age-appropriate toys and equipment. The house is well-lit, well ventilated, and free of defects or conditions that endanger children in care. The daycare is outfitted with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. All of the electrical outlets and trash cans are covered. Children have access to first-aid supplies.
***See Page 2 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINEZ, MARIA E.
FACILITY NUMBER: 380505839
VISIT DATE: 05/09/2022
NARRATIVE
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Cleaning products, detergents, and other items that could endanger children are kept out of reach of children. LPA observed no walkers, bouncers, or other similar items. According to the Licensee, there are no firearms or weapons on the premises. LPA observed that there were no pools, spas, or other bodies of water in the house.

LPA observed that the Licensee had posted all the required forms, including the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in family childcare homes.

During the inspection, LPA went over all the children's records. Each child has an emergency information card in their file that includes their full name, phone number, and the location of a parent or other responsible adult who can be contacted in an emergency. Each child's file contained parental authorization for the Licensee or registrant to consent to emergency medical care, as well as the child's physician's name and phone number.

LPA reviewed the licensee records. The licensee kept up to date with her Pediatric First Aid and CPR certifications. Additionally, LPA met with the Licensee to discuss supervision and capacity expectations/requirements. Although the Licensee does not transport children, she is aware that children should never be left in vehicles unattended.

*** See Page 3 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINEZ, MARIA E.
FACILITY NUMBER: 380505839
VISIT DATE: 05/09/2022
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Every six months, fire and earthquake drills are held and documented.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided:
*** See Page 4 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINEZ, MARIA E.
FACILITY NUMBER: 380505839
VISIT DATE: 05/09/2022
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US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPAs reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

The licensee was given both the “Notice of Site Visit” document and the Annual Inspection Report.

A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Maria Martinez.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4