<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004871
Report Date: 02/04/2022
Date Signed: 02/04/2022 04:56:13 PM

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, FRANCISCOFACILITY NUMBER:
414004871
ADMINISTRATOR:MARTINEZ, FRANCISCOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 533-9091
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:14CENSUS: 0DATE:
02/04/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Francisco MartinezTIME COMPLETED:
04:10 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 2/04/22 at 1:15pm, Licensing Program Analyst (LPA) Tapia-Mandujano met with applicant, Francisco Martinez for a schedule Prelicensing inspection at the facility. Purpose of visit was explained. Present in the home was applicant. Applicant has applied for a Large Family Child Care License.

Applicant rents a home which is a two bedroom, two bathroom single level hose with in law unit and backyard with a pool. Applicant lives with two minor children. The hours of operation are Monday-Friday 8am-5pm. DAY CARE AREA: In Law unit: Living Room, Bedroom #2, bathroom, and outside patio, and grass area in the backyard. OFF LIMITS AREA: Entire Front house, garage, driveway, and pool area in the backyard. All off limit areas are properly barricaded. LPA inspected applicant’s home for health and safety hazards.

LPA observed the following: Day-care is clean, orderly with a variety of age appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and thermometer. The home has pool that is properly barricaded with at least 5 ft. with a self latching door. Applicant has pets. Per applicant, there are no guns or weapons in the home. The home has age appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Discipline policy was discussed. Isolation area will be outside under rooftop.

The home has sufficient lighting and ventilation. Applicant states they will conduct an emergency drill once every six months and log drills. Applicant's CPR & First Aid expire on 06/2023. Mandated Reporter Training Certificate for applicant expire on 8/2023. Applicant was advised all adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility prior to having any contact with children in care, failure to do so could result in an immediate civil penalty of $100.00 each day.

Continued on Page 2...
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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, FRANCISCO
FACILITY NUMBER: 414004871
VISIT DATE: 02/04/2022
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
26
27
28
29
30
31
32
Page 2 Continued...

During the inspection the following was discussed and reviewed with applicant:
*Incidental Medical Services (IMS) policy
*Sick child and Food preparation policy
*Safe sleep handout and PIN 20-24 CCP
*Applicant was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Applicant was reminded about the Provider Information Notices (PINs) on CCLD website.
*Capacity limits of a Large License
*Reporting requirements and Covid-19 Technical Assistance

This report is discussed and explained to the applicant. Records to be Maintain in the facility was previously explained and copies were provided to applicant to use for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, Earthquake Preparedness Checklist, and Notification of Parents Rights Poster.

Prior to licensure, applicant must complete the following:
*Fire Department Clearance
*Missing documentation
*Safety Measures on Gas Protector

Copy of this report was emailed to the licensee at Noguez73@gmail.com. Signed copy of this report will be kept in the facility file and made available for public review. Desk Duty is available Monday through Friday between 8:00 AM - 5:00 PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2