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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543802879
Report Date: 06/27/2019
Date Signed: 06/27/2019 12:24:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MARTINEZ DAY CAREFACILITY NUMBER:
543802879
ADMINISTRATOR:MARTINEZ, MIREYA & RAULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 535-2456
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY:14CENSUS: 3DATE:
06/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Mireya MartinezTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA), Jose Penate, conducted an unannounced annual random inspection. LPA met with Licensee, Mireya Martinez, licensee is Spanish speaking. There are no pets at this home. There are no firearms or ammunition at this home. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There is a fireplace at this home that is not in use during day care hours. Fire drills are being conducted and documented at least once every six months. There is a working telephone and number was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the unfenced play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee is aware that children are never to be left in parked vehicles. All individuals residing at the home have criminal background/fingerprint clearances. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Pediatric CPR/First Aid are current and expire on 12/4/2019. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. IMS policy was discussed.

During inspection LPA inspected areas where infant’s sleep. LPA informed Licensee of Safe Sleep practices for infants and how to provide Safe Sleep environments. LPA informed Licensee to visit the Department’s website (www.ccld.ca.gov) for updates and changes related to licensing regulations and procedures.

Hours of operation are Monday – Friday 05:00AM – 05:00PM.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies cited today.



LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
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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