543903798-7-12-2019-04-CC-RGUZ-BDZRBM-20190712125258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543903798
Report Date: 07/12/2019
Date Signed: 07/12/2019 12:53:06 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, ELIZABETH FAMILY CHILD CARE		FACILITY NUMBER:	543903798
ADMINISTRATOR:	MARTINEZ, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 562-2561
CITY:	LINDSAY	STATE: CA	ZIP CODE:	93247
CAPACITY:	14	CENSUS: 0	DATE:	07/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Elizabeth Martinez		TIME COMPLETED:	01:15 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	Licensing Program Analysts (LPAs) Robert Gutierrez & Angelica Mejia conducted an unannounced annual inspection. LPAs met with Licensee Elizabeth Martinez. Licensee is Spanish speaking. LPAs conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Inspecting the back yard, LPAs observed a children’s play structure secured firmly to the ground. The rooms accessible to children in care are the master bedroom, living room, dining room, kitchen, hallway bathroom and back yard. Off-limits bedrooms and areas are made inaccessible via plastic door knob spinners, locks and safety gates. Two dogs and numerous canaries were observed during today’s inspection; licensee is aware of the safety of children around animals. There are no "bodies of water" or firearms in this home. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Some kitchen and restroom cabinets and drawers contain functional plastic latches making items inside inaccessible to children in care. LPAs inspected the remaining drawers and cupboards without latches and did not see items that could pose danger to children in care. Fireplace located the living room is screened and inaccessible to children in care. The fireplace is not used during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone (559) 562-2561 and number was verified. 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 maintains documentation of immunizations for pertussis, measles and influenza for herself. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Licensee is aware that children are never to be left in parked vehicles. All adults who reside or work in the home have a criminal record clearance or exemption. 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 is current and expires 01/23/2020. 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. Postings such as Emergency Disaster Plan, facility license and notification of parents rights poster are posted near the main entrance of the facility. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday – Saturday; 5:00 AM – 6:00 PM. Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MARTINEZ, ELIZABETH FAMILY CHILD CARE	FACILITY NUMBER: 543903798
	VISIT DATE: 07/12/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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

LPA & licensee discussed safe sleep regulations and lead information.

LPA left a copy of LIC 9227.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

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