455407575-11-20-2020-13-CC-CWIT-BVJU99-20201120142246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455407575
Report Date: 11/20/2020
Date Signed: 11/20/2020 02:22:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MARTINEZ, JEANETTE FAMILY CHILD CARE HOME		FACILITY NUMBER:	455407575
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	11/20/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jeanette Martinez		TIME COMPLETED:	09:30 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	A case management inspection was conducted by Licensing Program Analyst (LPA) Carrie Wisehart. The facility inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak. The licensee is requesting an increase in capacity not to exceed 14. The fire clearance was approved by the local fire authority on 11/10/20. Operational hours are 6:30am to 5:30pm, Monday - Friday. The residence is a one story, three bedroom/two bath home. There are two adults living in the home. The licensee understood that all adults residing or working at the facility must have a criminal background clearance on file with Community Care Licensing Department and is aware of the immediate civil penalty for adults working or residing in the home without a criminal record clearance. The accessible areas of the home are the living room, one bedroom and one bathroom. The areas in the home that are off-limits are the master bedroom, and first bedroom, master bathroom, kitchen, laundry room and the garage . These areas have been made inaccessible with safety door knob covers and door locks and gates. The back yard is the primary outdoor play area, and is fully fenced, free of debris, and safe for children. The home was clean and orderly at the time of inspection. There is one cat and one dog in the home and the food/water bowls are inaccessible to children. There is a working telephone in the home. The sharp knives are stored out of reach of children in the kitchen. Cleaning supplies and poisons are stored in a cabinet in the laundry room which is inaccessible and locked to children. Medications are stored in a locked kitchen cabinet. The home does not have a fireplace. The licensee stated there are no firearms/weapons on the premises. The children have access to age appropriate toys and equipment. The home is equipped with at least one working smoke detector, carbon monoxide detector and a charged fire extinguisher rated at least 2A10BC. (continued on page 2)

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MARTINEZ, JEANETTE FAMILY CHILD CARE HOME	FACILITY NUMBER: 455407575
	VISIT DATE: 11/20/2020

NARRATIVE

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(continued from page 1)

Parents' rights is posted. The licensee has completed a pediatric CPR/ First aid certification which expires on 6/2021. The licensee completed Mandated Reporter Training which expires on 8/5/21.

Incidental Medical Services (IMS) policy was discussed. The Licensee will send to CCL her IMS plan. 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. Safe sleep practices and lead exposure pamphlets were discussed with the licensee. The licensee understood the responsibility to read and have knowledge of the laws and regulations for the operation of a family child care home. Forms and regulations must be obtained from the website (http://ccld.ca.gov/). Megan's Law web site was provided at http://www.meganslaw.ca.gov. The licensee understood that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.
Notice of Site Visit shall be posted for 30 days from today's inspection. There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020

LIC809 (FAS) - (06/04)

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