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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208643
Report Date: 12/04/2019
Date Signed: 12/04/2019 10:58:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
566208643
ADMINISTRATOR:LEONILA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 486-7462
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 6DATE:
12/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Leonila MartinezTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Betzayra Cervantes and Michael Avila made an unannounced visit to conduct an Annual/Random inspection. LPAs met with Licensee Leonila Martinez and discussed the nature and purpose of the visit. LPAs toured the home with Licensee. Care of the children is facilitated in the living room and an adjoining smaller room where children sleep. LPAs discussed Safe Sleep with Licensee and provided a handout on Safe Sleep by the National Institute of Child Health and Human Development.

No toxins/hazards accessible were observed accessible to children in care. Licensee states there are no firearms stored on the property. LPA's observed are age appropriate toys and furniture readily accessible to children. The home has working smoke and carbon monoxide detectors. A 2A10BC fire extinguisher was observed mounted in the kitchen with a service date of 09/10/19. Licensee has a secured fence in the backyard and has age appropriate toys and play structures observed in good condition and free of hazards. Licensee's Pediatric CPR/First Aid certificate is valid through 4/27/2021. Licensee last conducted a fire/emergency drill on 06/06/2019. Licensee has all required forms posted for parent's to view. A sampling of children records was reviewed and found current and complete. No deficiencies were cited during today's visit. Licensee is reminded that she is responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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