434416705-2-16-2021-07-CC-SYIP-BYAUSX-20210216145104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416705
Report Date: 02/16/2021
Date Signed: 02/16/2021 02:51:18 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, JOANNA		FACILITY NUMBER:	434416705
ADMINISTRATOR:	JOANNA, MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 621-3938
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 1	DATE:	02/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Joanna Martinez		TIME COMPLETED:	10:10 AM

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) Samantha Yip conducted an announced pre-licensing inspection. Due to COVID-19 and shelter in place, a tele-inspection was conducted via Facetime. LPA met with Licensee/Applicant Joanna Martinez and explained the reason for this inspection. The purpose of this inspection is Licensee is requesting a change of location. Licensee is currently licensed at 3043 Bigwood Drive, San Jose 95127. LPA informed Licensee that a copy of this report dated 02/16/2021 will be emailed to her. Licensee's response to email within 24 hours will serve as acknowledgement that report was received. Present during today's inspection were Licensee and her two minor children. There were no daycare children present during today's inspection. Licensee does have an area to post required positing; license, emergency disaster plan, notification of parent's right, and earthquake preparedness checklist. The hours of operation are Monday through Friday 6AM to 6PM. There is working phone in the home. Licensee owns the home and does have daycare insurance. Licensee guided LPA on a tour of the home via Facetime. A fire clearance for 14 was granted on 02/12/2021. The off-limit areas of the home are the master room, master bathroom, room 2, garage, and the right and left side of the yard. There are no stairs in the home. There is a fireplace in the home, which is barricaded. All disinfectant, cleaning supplies, and other items that are dangerous to children were stored inaccessible to children. LPA observed that there is sufficient amount of toys for children in care. LPA discussed with Licensee about safe sleep. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, functioning smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, stored in the home. Licensee will be using the backyard, which is fenced. There were no bodies of water observed during today's inspection. ---------------------CONTINUES ON 809 DATED 02/16/2021 PAGE 1----------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021

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, JOANNA	FACILITY NUMBER: 434416705
	VISIT DATE: 02/16/2021

NARRATIVE

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---------------------CONTINUATION 809 DATED 02/16/2021 PAGE 1-----------------------------
Licensee does not plan on transporting or providing Incidental Medical Services. Licensee understands that children cannot be left alone and unattended in parked vehicles.
Licensee also understands that children's personal rights cannot be violated; including no corporal punishment. LPA emailed family child care home forms on 02/12/2021.

Licensee has a valid CPR/1st Aid expires on 07/20/2021. Licensee's immunization records for measles and pertussis on file; along with her Preventive Health, Safety, and Nutrition certificate and Lead Poisoning Prevention Training. Licensee completed the Mandated Reported training on 04/2020. LPA reminded Licensee that Mandated Reporter Training requires renewal every 2 years.

The adults living in the home are Licensee and her spouse. All adults having cleared criminal record, child abuse index clearance, or exemptions, and TB test results. Licensee's TB test results are on file. Licensee stated that she will submit TB test results and LIC 508: Criminal Record Statement for her spouse. LPA informed 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 stated that she will submit the following:
- updated LIC 279B
- LIC 508 for her spouse
- TB test result for her spouse
- Deed of her home

LPA conducted an exit interview with Applicant. LPA advised Licensee upon approval of Licensing Management, a license for a Large Family Child Care Home will be granted and issued to Licensee upon completion of:
- transferring fingerprints through Guardian

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021

LIC809 (FAS) - (06/04)

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