197494918-9-21-2026-58-CC-NMOY-DY5V37-20260921160415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494918
Report Date: 09/21/2026
Date Signed: 09/21/2026 04:04:53 PM

Document Has Been Signed on 09/21/2026 04:04 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MARTIN FAMILY CHILD CARE		FACILITY NUMBER:	197494918
ADMINISTRATOR/ DIRECTOR:	KATHARINE MARTIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 667-6624
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 3	DATE:	09/21/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Katharine Martin, Licensee		TIME VISIT/ INSPECTION COMPLETED:	02:44 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Nathanael John Mooberry, conducted an unannounced annual visit to the above facility on 09/21/2026, at 12:30 AM. LPA identified self and the reason for the visit, and met with Katharine Martin, Licensee, who guided LPA on a tour of the home. LPA provided Entrance Checklist - Child Care Homes (LIC 126) to facilitate the inspection. There were three (3) children with two (2) Staff present. Adults in the home were discussed and all have criminal record clearance. Also present were Licensee’s Assistant, Katharine P. Martin. This program serves children ages 6 weeks to TK. This program operates Monday - Friday 7:00 AM - 5:00 PM. The facility is currently licensed for a capacity of 14. Per Licensee, they currently have 6 children enrolled. The Children's Roster was not available for review posing a potential risk for children in care. License, Notification of Parents’ Rights and Earthquake Preparedness were observed posted in the day care room at the time of inspection. This is a single story home which consists of a living/dining room, kitchen, day care room, two (2) bedrooms and two (2) bathrooms. The home does not have a fireplace. Areas which will be used by children include the living/dining room, kitchen, day care room, bathroom 1, and the backyard. There is no garage. The washer and dryer are located off the kitchen. ---Pg. 1 of 5

Rita Ramos
Nathanael Mooberry
	DATE: 09/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2026

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197494918
	VISIT DATE: 09/21/2026

NARRATIVE

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All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating (central) for the safety of the children. LPA did not observe any fireplaces or open face heaters. There is a working mobile telephone maintained in the home. LPA observed age appropriate toys and play equipment/materials free of loose and/or sharp objects.

There was one crib or play yard for each infant who is unable to climb out. Cribs and play yards were free from loose or hanging objects. Placement of cribs and play yards did not hinder entrance or exit to and from sleeping area. Mattresses were made for the cribs or play yards, but were covered with loosely fitting sheets creating a potential hazard to children in care. Soiled bedding was inaccessible to children. No sleeping in car seats.

No infant walkers, no Johnny jumpers, no saucer chairs, no incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

A written Disaster Plan (LIC 610A) was observed. LPA observed fire/disaster drill log. Last drill was conducted 06/19/2026. The valve on the 2A 10BC fire extinguisher indicates fully charged with receipt dated 08/03/2026. The home is equipped with a smoke and carbon monoxide detector, which was operational. Per Licensee, the First Aid kit is kept in the day care room. The First Aid kit was inventoried for necessary supplies.

Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee states there are poisons locked up under the kitchen sink. The Licensee understands that poison must be locked with a key or a combination lock.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Per licensee, there are two dogs and four cats that are kept in the bedroom (off-limits). LPA did not observe the pets at the time of visit. Per Licensee, there are no weapons or firearms in the home. LPA observed no bodies of water around the premises. Per Licensee, smoking is prohibited on the premises.
Per Licensee, isolation area for sick children is in the living room.
---Pg. 2 of 5

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2026

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197494918
	VISIT DATE: 09/21/2026

NARRATIVE

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There were no pools or bodies of water observed on the premises.

Per licensee, the children will have access to the backyard area. LPA observed backyard has artificial grass and adequate perimeter fencing through-out the yard. LPA advised Licensee that outdoor supervision is required at all times. LPA observed all trees, shrubs, and plants are maintained.

Per Licensee, food/meals are provided to children in care (breakfast, lunch, and afternoon snack). Drinking water was readily available with the use of filtered water.

Emergency Information, Emergency Consent, Liability Insurance, and Notification of Receipt of Licensing Reports were readily available in the children's files during today's inspection. Notification of Parents' Rights and Immunization Records were missing from one of two children's files. Technical Violations were given.

Proof of current Pediatric First Aid and CPR training, immunization against influenza, pertussis, and measles, TB Clearance or Risk Assessment, Requirement to report Child Abuse, and Employee Rights were readily available in the staff files during today’s inspection.

— Licensee - Pediatric First Aid and CPR Card valid until: 10/29/2026
- Mandated Reporter AB1207 valid until: 11/14/2026
— Assistant - Pediatric First Aid and CPR Card valid until: 10/29/2026
- Mandated Reporter AB1207 valid until: 11/14/2026

---Pg. 3 of 5

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2026

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197494918
	VISIT DATE: 09/21/2026

NARRATIVE

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LPA 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) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

All adults living in the home and staff working with children have criminal record clearance on file.
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.

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.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2026

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197494918
	VISIT DATE: 09/21/2026

NARRATIVE

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Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

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.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] 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 this facility inspection conducted on 09/21/2026, the following deficiencies were issued:

Physical Plant - Type B: 102425(a)(4) - Sheets were not fitted to the bed being used.
Records - Type B: 102417(g)(8) - Current roster was not available.

The following Advisories were issued:

Records - Technical Violation: 102419(d)(1) - 1 of 2 children's records reviewed was missing the LIC 995.
Records - Technical Violation: 102418(g) - 1 of 2 children's records reviewed were missing Immunization Records.

Exit interview was conducted and report and appeal rights were reviewed with the Licensee. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility.

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

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Nathanael Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/21/2026 04:04 PM - It Cannot Be Edited

Created By: Nathanael Mooberry On 09/21/2026 at 03:06 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 197494918
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)(4)

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. (4) Mattresses shall be made specifically for the size crib or play yard in which they are placed. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in onebed did not have tight fitting linens which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/02/2026
	Plan of Correction
1 2 3 4	Licensee will email photos of tight fitted sheets on bed to LPA by Correction date of 10/02/2026.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in that a current children's roster was not available which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/02/2026
	Plan of Correction
1 2 3 4	Licensee will email photo of children's roster to LPA by Correction date of 10/02/2026.

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

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Nathanael Mooberry
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2026

LIC809 (FAS) - (06/04)

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