444416383-9-10-2021-07-CC-CNEN-C6QTBX-20210910143554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416383
Report Date: 09/10/2021
Date Signed: 09/10/2021 02:36:01 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, JESSICA		FACILITY NUMBER:	444416383
ADMINISTRATOR:	MARTINEZ, JESSICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 331-9289
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 7	DATE:	09/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jessica Martinez		TIME COMPLETED:	02:45 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	#2 Licensing Program Analysts (LPAs) Cortney Nelson and Marilou Monico conducted an unannounced Required - 1 Year inspection. LPAs met with Licensee, Jessica Martinez, and explained the purpose of today's visit. Also present in the home were five daycare children including four toddlers and one infant, and Licensee's two children, one in kindergarten and one infant. There are five adults and four children residing in the home: Licensee, Licensee's mother and father, Licensee's younger sister, Licensee's grandmother, and Licensee's boyfriend. Additionally in the home are Licensee's two children and Licensee's younger brother and sister. The daycare is open Monday thru Saturday from 6:00 AM to 6:00 PM. The indoor and outdoor areas were inspected. There is a 2A40BC fire extinguisher. There were no bodies of water observed. Off limit areas in the home: kitchen and four bedrooms. Off limit areas outside the home: garage and two storage rooms. Cleaning compounds, sharp objects, and other similar items were stored inaccessible to children. Licensee maintains a current children's roster and LPAs obtained a copy during the inspection. The last fire/disaster drill was conducted on August 20th, 2021. Per licensee, there are no weapons in the home. Five children's files were reviewed and all required documents were present. Licensee has current Pediatric CPR/First Aid certifications. LPAs advised Licensee that children residing in the home who turn 18 years old have one month after their birthday to obtain fingerprint clearances. LPAs discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. Mary's Mandated Reporter Certificate expires on May 11th, 2023. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Continuation on next page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2150
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARTINEZ, JESSICA	FACILITY NUMBER: 444416383
	VISIT DATE: 09/10/2021

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

LPAs reviewed with Jessica and provided her a copy of Safe Sleep Regulations (PIN 20-24-CCP).

A review of staff records during today's inspection indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Incidental Medical Services (IMS) was discussed. Licensee stated that she's not planning to provide IMS at this time but may follow IMS as used by Head Start Migrant Program.

As a result of this inspection, no deficiencies were cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2150
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2