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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208643
Report Date: 07/21/2022
Date Signed: 07/21/2022 01:48:49 PM


Document Has Been Signed on 07/21/2022 01:48 PM - It Cannot Be Edited

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: 0DATE:
07/21/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Leonila MartinezTIME COMPLETED:
01:20 PM
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On July 21, 2022 at 1:02 PM an unannounced Case Management- Temporary Suspension Order (TSO) was conducted on this date by Regional Manager (RM) Adriana Hernandez and Licensing Program Analyst (LPA) Laura Villanueva. The purpose of the Inspection was to serve Licensee with the Temporary Suspension Order (TSO) and Immediate Exclusion of Salomon Martinez. The Temporary Suspension Order, TSO, and exclusion were left at the front door of the facility. Licensee was not present at the home.

The following documents were served to Licensee:
1) Statement to Respondent
2) Government Code Sections
3) Notice to Respondent
4) Accusation (Revocation and Exclusion)
5) Request for Discovery
6) Notice of Defense (2 copies)
7) Closed for Business Sign
8) Summary Instructions for Licensee
9) Order for TSO


The Temporary Suspension Order – CLOSED FOR BUSINESS notice was posted by RM on the front door entrance. Licensee is being informed that removal of this notice constitutes a violation of the law, a misdemeanor fine of up to $500.00. This notice shall be posted until further notice by the Order of the Director of the Department of Social Services. Licensee is being informed she must cease operation by the close of business today. The licensee is required to provide a copy of the Accusation to each parent and/or Authorized Representative (AR).

Continued on LIC 809C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 566208643
VISIT DATE: 07/21/2022
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There were no children present during today’s inspection however, 15 parent/Authorized Representative packets were provided and left at the front door entrance for the licensee to distribute. Licensee must maintain in children’s files Acknowledgement of Receipt of Licensing Reports form LIC 9224 signed by each parent. Copy of this TSO will be mailed to the local Resource & Referral agency.

Exit interview was not conducted with Licensee, Leonila Martinez due to her not being present. Notice of Site Visit and Appeal rights were left at front door. Copy of this licensing report was left at front door entrance of the facility, will be mailed certified and sent via email address on file to the licensee. Any further communication should be directed to our Department Legal Division.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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