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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213876
Report Date: 06/10/2022
Date Signed: 06/10/2022 02:05:24 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/10/2022 02:05 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
426213876
ADMINISTRATOR:SANDRA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 739-8802
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 0DATE:
06/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Sandra MartinezTIME COMPLETED:
02:15 PM
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

Licensing Program Analyst (LPA) Martina Jimenez made a RANDOM ANNUAL visit to the home. Met with Sandra Martinez, Licensee. There were no children present. Licensee states that she is currently not providing day care. She states that the last day that licensee provided care was November 14, 2021.

A tour of the home was made both inside and outside. Licensee has a 2A10BC fire extinguisher, smoke detector and carbon monoxide detector. Licensee was reminded to service or replace the fire extinguisher yearly. LPA discussed the requirement for all care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles.

LPA also discussed the Mandated Reporter training requirements. LPA provided and reviewed the Care Provider's Guide to Safe Sleep (PIN 20-24-CCP-SP) Handout with Licensee. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.

Licensee requested to be on Inactive Status. Licensee submitted LIC 9211 (Request for Inactive Child Care License Status) to LPA during the visit.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
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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