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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409540
Report Date: 06/17/2024
Date Signed: 06/17/2024 11:38:04 AM

Document Has Been Signed on 06/17/2024 11:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:TEJADA-MARTINEZ, CRISTINA & MARTINEZ, HAROLDFACILITY NUMBER:
073409540
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, CRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 375-1769
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
06/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Cristina & HaroldTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Dealia Frison and Christina Watts conducted a Change of Location scheduled inspection. Present during today’s inspection was the Applicants's Cristina and Harold Martinez and their infant daughter.

The home was toured for Health and Safety Inspection. This is a one story home which consist of 3 bedrooms, 2 bathrooms, living room, dining room (daycare), kitchen, attached garage, laundry room and backyard. On limits area consist of dinning room, kitchen, living room, backyard and the hallway bathroom. Off limits area consists of all three bedroom rooms, master bathroom, laundry room and attached garage. Off limits areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. LPA's observed a fire table in the backyard. LPA's observed applicant disconnecting gas from table. LPA's reminded applicant's to either keep gas detached from fire table or lock fire table while children are in care. There are no firearms on the premises as stated by the Applicants. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. The fireplace is Electric and screened to prevent access by children. LPA verified that the fire extinguisher 3A40BC is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced.

The Applicant's has current CPR and First Aid which expires 2/2025. Mandated reporter training was completed and expires 7/11/2025. Applicant's is in compliance with required immunization's for childcare providers.
LPA reminded Applicant's Fire and disaster drills are conducted at least once every six months.

LPA's discussed the safe sleep regulations with Applicants and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TEJADA-MARTINEZ, CRISTINA & MARTINEZ, HAROLD
FACILITY NUMBER: 073409540
VISIT DATE: 06/17/2024
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LPA also informed Applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant's was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TEJADA-MARTINEZ, CRISTINA & MARTINEZ, HAROLD
FACILITY NUMBER: 073409540
VISIT DATE: 06/17/2024
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 Applicant's was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Applicant's confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Fire clearance was approve by Nicole Donovan Contra Costa County Fire Protection District on 5/20/24. As of 6/17/2024 the Applicants have been approved for a large daycare home.

Exit interview conducted and report was reviewed with the Applicant's Cristina and Harold.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
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