434416253-12-19-2019-07-CC-YHUG-BJZUHR-20191219143621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416253
Report Date: 12/19/2019
Date Signed: 12/19/2019 02:36:26 PM

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, MARGARITA		FACILITY NUMBER:	434416253
ADMINISTRATOR:	MARGARITA MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 401-4595
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY:	14	CENSUS:	DATE:	12/19/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Margarita Martinez		TIME COMPLETED:	02:50 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	Licensing Program Analyst (LPA) Oscar Huang met with Licensee, Margarita Martinez for an announced inspection in response to licensee relocation. Licensee currently has a large FCCH license (#434415342) located at 2479 Glen Exteter Way, San Jose, CA 95148. LPA explained the nature of today’s inspection to Licensee. Present were licensee's daughter and no children at home. Days and hours of operation are Monday to Friday, 6:00am to 6:30pm. The adults that reside in the home are Licensee, and her adult daughter. A review of staff records on today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come 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. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, Licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Licensee was advised to keep temperature within 68-85 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. LPA observed no stairs inside the home. The main area of the home is used for the day care are living room, dinning area, and bathroom #1(front bathroom). LPA observed no fireplaces. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored in top cabinets in the kitchen inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, at least one working combined smoke and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: all bedrooms, bathroom #2, fenced kitchen, and attached garage. LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: None. Facility Evaluation Report dated 12/19/2019 to be continued on next page:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

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, MARGARITA	FACILITY NUMBER: 434416253
	VISIT DATE: 12/19/2019

NARRATIVE

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Facility Evaluation Report dated 12/19/2019 to be continued from previous page:
Licensee rents the house. Owner/Landlord Notification & Consent were submitted and on file. Licensee stated she will transfer the child care liability insurance once the license is approved. LPA advised licensee that before the insurance is obtained, she will need to obtain signed Affidavit Regarding Liability Insurance For Family Child Care Home from parents of children in care and keep it on each child's file. LPA observed Licensee has current CPR and First Aid certification expiring 06/16/2020. LPA also observed licensee' proof of Preventative Health and Safety Child Care Training on file, taken on 09/30/2017, which includes an hour of nutrition class.
Supervision of children was discussed with Licensee, and she understands that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. Licensee states that they do not transport children via vehicle but they understand that children cannot be left in parked vehicles unattended at any time. LPA reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing. LPA also discussed infant sleeping accessaries with licensee.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records for immunization against measles, pertussis, and influenza for Licensee on file.
Incidental Medical Services (IMS) were discussed with Licensee. Licensee is not providing IMS at this time. 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.

LPA discussed Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training web site is available at: http://www.mandatedreporterca.com/. Licensee & her daughter requested to be exempted as English is not their primary language until the Spanish version becomes available.

A fire clearance approval from the San Jose Fire Department was granted on 10/16/2019.

No Deficiency was cited. Exit interview conducted with Licensee, and advised her that her large family child care home at this new location is now pending upon submit the following items & management approval:

1: Licensee & her daughter, Diana influenza proof of records or decline statements.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

LIC809 (FAS) - (06/04)

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