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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407575
Report Date: 07/30/2021
Date Signed: 07/30/2021 02:09:34 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 HOMEFACILITY NUMBER:
455407575
ADMINISTRATOR:MARTINEZ, JEANETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 356-0424
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY:14CENSUS: 5DATE:
07/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Jeanette MartinezTIME COMPLETED:
12:08 PM
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An Annual inspection was made to the facility by Licensing Program Analyst (LPA), Mendez. A review of staff records on 7/30/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection the home and grounds were toured. The licensee and assistant were supervising 5 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7:30 AM to 5:30 PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The home was clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expired in 6/2021 and is scheduled for CPR class for 9/8/21 and 10/14/21. Mandated reporter training was completed on 8/5/19. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons are locked in a lock box. There is a working carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. There are no firearms in the household..

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
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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