197492900-3-21-2024-54-CC-AMOY-D3KW33-20240321165517

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197492900
Report Date: 03/21/2024
Date Signed: 03/21/2024 04:55:24 PM

Document Has Been Signed on 03/21/2024 04:55 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	197492900
ADMINISTRATOR:	MARTINEZ, JASMINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 427-0134
CITY:	COMPTON	STATE: CA	ZIP CODE:	90222
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	03/21/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Francisca Martinez, Assistant		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Annual Inspection on this date. Upon arrival at 10:30am LPA met with Francisca Martinez, Assistant, and explained the purpose of inspection, LPA provided the inspection Entrance Checklist, LIC 126. , LPA toured the home. There were two (2) children present upon arrival. At 10:40am LPA observed Child #1, a 7 month old infant, laying in play yard wearing an oversized Sleep Sac (size 12-24months) (photo taken), posing a potential risk to the health and safety of children in care. LPA discussed Safe Sleep regulations and precautions with staff. Staff removed the the sleep sac from infant and laid infant in play yard. Licensee Jasmine Martinez was not present during inspection.

Per Assistant, the current hours of operation are Monday-Friday 6:00am-6:pm. The licensee offers overnight care, LPA discussed with licensee that "Overnight Care" means care being provided to children anytime between the hours of 6 p.m. and 6 a.m. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

The home is a single story, two (2) bedrooms and one (1) bathroom. The home is clean, orderly, comfortable and well ventilated. The home has central air and heating. Per licensee, the areas used by children include: The living room, dining room, bathroom and back yard. Off limit areas are: Two bedrooms, detached garage. The children have access to the kitchen and laundry room as they use it as a walk way to backyard.

At 10:45am LPA observed an individual in the backyard painting aluminum patio cover. Per Assistant, the work will last until 3/24/24 During which the children will no have assess to the back yard and have planned activities inside the home. Areas used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. Rooms that are off-limits need to be made inaccessible during operating hours. LPA observed safety door knobs on bedroom doors. ----Page 1 Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197492900
	VISIT DATE: 03/21/2024

NARRATIVE

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LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted in the living room in a location visible to parent/guardians of children in care. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

The licensee provides food for children in care. LPA discussed proper storage of food if brought from home, food allergies and precautions.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on March 2024, The home maintains telephone service via cell phone.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that cleaning compounds are in kitchen and bathroom inaccessible to children. The bathroom that children use is located in the observed to be clean and free of hazards.

Per facility representative there are no firearms or weapons stored in the home.

Isolation area for sick children waiting to be picked up is in living room, away from the other children.

LPA discussed Safe Sleep regulations including 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Per Facility Representative infants sleep in the living room, each infant has their own play yard. Staff supervise infant for the duration of the nap and will document 15 minute checks.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials. LPA did not observe any objects that could be hazardous to children in care. Facility does not have a pool or similar bodies of water. Licensee has two small dogs, observed in a kennel. -------------------Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197492900
	VISIT DATE: 03/21/2024

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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months).

Licensee and Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

At 12:24pm LPA spoke with Licensee over the phone, Licensee disagreed with deficiencies and stated they will appeal . Based on the LPA's observations and records review two "B" deficiencies will be cited today in accordance with California Title 22 Regulations. LIC 809D

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Assistant, Francisca Martinez, Appeal Rights were discussed and a copy provided. Facility Representative refused to sign report.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/21/2024 04:55 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 03/21/2024 at 12:47 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197492900
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type B

Section Cited

CCR

102425(a)(3)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above due to the child #1 was laying in a play yard with sheet not fitter or appropriate to the mattress size which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/25/2024
	Plan of Correction
1 2 3 4	Per Assistant, the sheet will be removed and replaced with one that fits. A photo will be sent to LPA by POC due date

Request Denied

Type B

Section Cited

CCR

102423(a)(2)

Personal Rights

(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 out of 1 infant (age 7months) was napping in play yard wearing an oversized sleep sac size 12-24 months (photo taken) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/25/2024
	Plan of Correction
1 2 3 4	Per phone conversation with licensee Jasmine Martinez, they don't agree with defeciency and will appeal

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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