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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700105
Report Date: 03/09/2022
Date Signed: 03/09/2022 09:44:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2022 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20220111135546
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197700105
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
03/09/2022
UNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Virginia MartinezTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Allegation #4 Facility is operating outside of license terms and conditions
INVESTIGATION FINDINGS:
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LPA Isabel Ortega conducted a subsequent visit to the facility for the purpose of concluding and deliver findings into the allegation above. LPA met with licensee, Virginia Martinez. Upon arrival LPA observed 8 children and 1 staff.
This investigation consisted of interviews with the licensee, witnesses, staff, children, and other pertinent parties relevant to the investigation. The investigation revealed the following evidence:
The investigation revealed that in the month of January 2022, 17 children were signed in for care at Martinez Family Child Care Home. The facility was over the capacity allotted and specified on the license. Furthermore, interviewed disclosed more than 8 children are present at the same time in care. Therefore, the investigation provided sufficient evidence and corroboration to substantiate the allegations. The above allegation: Facility is operating outside of license terms and conditions based on evidence obtained during course of the investigation is deemed to be Substantiated.

continuation Page........................
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 12-CC-20220111135546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
VISIT DATE: 03/09/2022
NARRATIVE
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A finding of substantiated means that allegation is valid because the preponderance of the evidence standard has been met. This facility was cited today in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes.

The facility was cited Type A according to the California Code Title 22 Regulations. See Facility Evaluation Report LIC 9099D for deficiencies.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview conducted, appeal rights discussed, and a copy of this report was provided to licensee.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 12-CC-20220111135546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
03/09/2022
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity
The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by:

In the month of Jan.22 R&R subsidy Child care time sheets(CCRC) reflect licensee was caring
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Licensee will cease providing care for more than allowable at one given time according to current license for a small family child care home. Licensee will provide a schedule of enrolled children of days and times each child enrolled attends care to the Palmdale RO by email or fax by 3/14/22.
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for a total of 17 children at one time(2pm4pm) Monday - Friday, this is above the amount specified on the license. According to the current roster provided Licensee has 23 children enrolled. This is a type A deficiency that poses an immediate health and safe risk to children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC9099 (FAS) - (06/04)
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