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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585407073
Report Date: 11/22/2019
Date Signed: 11/22/2019 12:12:03 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, LAUREL FAMILY CHILD CARE HOMEFACILITY NUMBER:
585407073
ADMINISTRATOR:MARTINEZ, LAURELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 960-8343
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY:14CENSUS: 5DATE:
11/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Laurel MartinezTIME COMPLETED:
12:15 PM
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A case management inspection was conducted by LPAs Emilia Grisak and Mikah Martinez who met with licensee Laurel Martinez. Case management inspection is regarding an incident that occurred on 4/3/19 in which a child was allegedly bitten by the licensee’s dog. During today’s inspection interviews were conducted with the licensee and children. It was stated during interviews with children that none of the children are afraid of the dogs at the home. It was also stated during an interview with the licensee that the incident occurred when the dog was a puppy and was playing with the children in the backyard. It was stated the child did obtain a scratch mark from the puppy on the heel of the leg but parents were notified after the incident and the puppy was put on a leash till it was trained. It was stated by the licensee and parent that no medical attention was required and the child's parent was immediately contacted. Based on information that was provided, no deficiencies were cited during today's visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia GrisakTELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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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