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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409732
Report Date: 07/16/2019
Date Signed: 07/16/2019 01:25:03 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MARTINEZ, EDITHFACILITY NUMBER:
434409732
ADMINISTRATOR:EDITH MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4082511732
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 7DATE:
07/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Martinez Edith TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee, Martinez Edith and explained the purpose of today's inspection. Days and hours of operation are Monday through Friday from 07:00 AM – 5:30 PM.

There are 3 adults residing in the home: Licensee, and Licensee’s Husband Martinez Miguel and her mother Josefina Tinoco . Present during the inspection today was the Yajaira Coromoto Teran (Assistant Provider) and 7 children in care. Edith’s 2 sons and her 7 year old daughter as well as # 2 infants, and 4 preschoolers.

A review of staff records show that Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MARTINEZ, EDITH
FACILITY NUMBER: 434409732
VISIT DATE: 07/16/2019
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LPA reviewed with Licensee the maximum capacity for a Large Family Child Care Home License.
Licensee that when Licensee does not have a Helper present, Licensee can only care for up to 8 children at any one time in the home and must follow the capacity requirement of a small Family Child Care Home.

Licensee states that currently she is not providing Incidental Medical Services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

No Regulatory violations were observed during the inspection visit. Exit Interview was conducted, A copy of this report was given to Licensee.




A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MARTINEZ, EDITH
FACILITY NUMBER: 434409732
VISIT DATE: 07/16/2019
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Licensee's Pediatric CPR and First Aid expires on 04/27/2021 . Licensee has records showing proof of immunity against Measles and . Licensee's AB1207 Mandated Reporter Training Certificate is dated 01/05/2018. Assistant Provider Yajaaira Coromoto Teran, primary language is Spanish and is awaiting Spanish general updated training and test.

LPA reviewed the roster of children in care and a copy was obtained. LPA reviewed the children's files. Records reviewed include Parents' Rights, immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. Licensee maintains and submitted proof of Liability insurance.

LPA inspected the indoor and outdoor areas of the home. Smoke and Carbon monoxide detectors were tested and proved to be functioning. Fire and disaster drills were last conducted and recorded on 07/28/2019. PA observed a fully charged fire extinguisher. The fireplace is barricaded.
Licensee states there are two weapons (handguns) in the home. The weapon are stored in a safe in the master bedroom which is off limits to children. The ammunition is stored in the second off limit bedroom in a locked cabinet inaccessible to children.

Licensee has one small sized pet dog that is not accessible to the day care children. Per Licensee, the dog is current with vaccination. The backyard is fenced, and the part used by children is enclosed by fencing. Licensee stated that the children do not use the unless surprised. There were no bodies of water observed.

Licensee stated she does not transport children. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.




SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
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