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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492900
Report Date: 05/15/2025
Date Signed: 05/15/2025 02:45:44 PM

Document Has Been Signed on 05/15/2025 02:45 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197492900
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, JASMINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 427-0134
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
05/15/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:38 AM
MET WITH:Licensee Jasmine MartinezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 5/15/25 at 11:38am, Licensing Program Analysts (LPA) Tyler Reyes and Alicia Mooberry conducted an unannounced Annual/Random inspection at the above facility. LPAs met with Licensee Jasmine Martinez and provided an Entrance Checklist-Family Child Care Homes LIC 126 LPAs conducted a tour of the facility led by Licensee Jasmine. LPAs observed (1) child in care during inspection. Hours of Monday through Sunday 6am-6am. LPAs discussed with applicant that “Overnight Care” means care being provided to children anytime between the hours of 6pm and 6am. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care. The licensee is approved to for MAXIMUM CAPACITY (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAPACITY 14 - NO MORE THAN 3 INFANTS. ONE CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. THE.

During the inspection, the following individuals were present in the home: Licensee Jasmine and Staff 1 (S1) Any individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. LPAs informed that any individual that has direct contact with the children are required to have a criminal record clearance or exemption. Licensee Jasmine states their child is currently 17 years old. Licensee Jasmine was informed that upon turning 18 years old, the individual must complete a criminal record clearance and association to facility roster. An updated LIC 279 and LIC 279B form must be submitted to the Regional Office.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492900
VISIT DATE: 05/15/2025
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Facility Postings: LPAs observed the required posting in the living room on bulletin board Facility License, PUB 394 Notification of Parents Rights, LIC 9148 Earthquake Preparedness, and LIC 610A Emergency Disaster Plan.

Pediatric CPR/First Aid in Pediatrics Certification: Licensee Jasmine American Heart Association 03/2026

Emergency Disaster Drill: Fire and Earthquake Drill conducted 04/04/2025

Facility Sketch: The facility is a single-story structure that consist of a front yard, living room, kitchen, laundry area, (1) restroom, (2) bedrooms, daycare room, garage and backyard.

On-Limits areas: Front yard, living room, kitchen, laundry area, (1) restroom, and backyard. Licensee requested to use daycare room. An updated facility sketch was submitted, and approval was received from the Los Angeles County Fire Department on 4/14/25. During today’s visit, the room was observed to be clean, organized, and in good repair. Age-appreciate toys and materials were present and accessible.

Off-Limits area: (2) bedrooms and garage.

Infants: LPAs observed no infants in care. Napping equipment was observed, including (1) play yard equipped with a mattress and fitted sheet. An Infant Sleep Chart was observed, which included the date, section for infant's name, and section of each 15-minute check. Based on record review Licensee Jasmine was not able to provide Child 1 (C1) LIC 9227 Individual Sleep Plan which poses a potential health and safety risk to children in care.

Meals: Per Licensee Jasmine children will have meals in dining room. Licensee Jasmine provides meals for children. Licensee Jasmine was advised to ensure all food brought from home is properly labeled and stored. Per Licensee Jasmine no children have reported food allergies.

Medication: Per Licensee Jasmine the facility will provide incidental medical services. If required, medication will be inaccessible to children by centrally storing and locking. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training. Personal medication centrally stored and locked in hallway cabinet.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492900
VISIT DATE: 05/15/2025
NARRATIVE
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The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. LPAs observed age-appropriate toys and learning materials. Telephone service is provided via cell phone. LPAs observed an electrical fireplace in living room unsecured and accessible to children. The electrical fireplace has small heating vents which poses a potential health and safety to children in care. LPAs observed with Licensee Jasmine the electrical fire place was hot to touch.

The facility provides heating and cooling through a central air system. LPAs observed a 2A10BC fire extinguisher located in dinning room fully charged with a service date 03/05/2025. The home has an operable smoke and carbon monoxide detector. The first aid kit was observed in kitchen cabinet. Isolation area for sick children is in separate area of living room.

No poisons are kept on facility grounds. Cleaning products are centrally stored in underneath kitchen sink by child safety latch. There are no personal hygiene supplies accessible to children in the restroom. There are no firearms on the premises. If firearms are present, LPAs verified per Title 22 regulations that they are locked, with ammunition stored separately. LPAs observed facility has childproof electrical outlet covers. Per licensee Jasmine there (3) pets.

Outdoor: Children are using the front and backyard for outdoor play. The facility backyard is enclosed. Per Licensee Jasmine children are supervised during outdoor play. LPAs observed that the outdoor yard has toys and other equipment for children to play with. LPAs did not observe any objects that could be hazardous to children in care. No animal feces were observed. There are no pools or spas, or other bodies of water.

Staff Files: LPAs reviewed Licensee Jasmine and S1 files which included the following documentation: LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirements to Report Child Abuse, Proof of Immunizations, and Mandated Reporting Training Certificate. (2) of (2) staff has required documentation.

Children Files: LPA reviewed (3) child files, which included the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 9224 Acknowledgment of Receipt of Licensing Reports it was not applicable. Per Licensee Jasmine C1’s file was unavailable for review. The missing of C1’s file poses a potential health and safety risk to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492900
VISIT DATE: 05/15/2025
NARRATIVE
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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.

Licensee 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.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, the LICENSEE Jasmine, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492900
VISIT DATE: 05/15/2025
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and Appeal Rights provided with Licensee Jasmine. Please see attached LIC 809-D for citations. (2) Type B's were issued.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2025 02:45 PM - It Cannot Be Edited


Created By: Tyler Reyes On 05/15/2025 at 02:03 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: 05/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in an electrical fireplace in living room unsecured and accessible to children. The electrical fireplace has small heating vents which poses a potential health and safety to children in carewhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2025
Plan of Correction
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Licensee will ensure fireplaces shall be screened to prevent access to children. Licensee Jasmine states will remove electrical fire place from facility. Licensee will provide proof of removal to LPA Reyes by POC Due Date via email.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in C1's file was not not available for review. Per Licensee Jasmine C1’s file is with their guardian which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/22/2025
Plan of Correction
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Licensee Jasmine will ensure each child has a file readily available for review. Licensee Jasmine will provide proof by POC Due Date C1's LIC 282, Immunization Record, LIC 700, LIC 627, LIC 995A, and LIC 9227 via email to LPA Reyes.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2025


LIC809 (FAS) - (06/04)
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