197700105-6-29-2022-12-CC-IORA-CFUSUS-20220629141136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700105
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:11:43 PM

Document Has Been Signed on 06/29/2022 02:11 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	197700105
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 7	DATE:	06/29/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:44 AM
MET WITH:	Virginia Martinez		TIME COMPLETED:	02:25 PM

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On 6/29/2022 , Licensing Program Analyst (LPA) Isabel Ortega was greeted virtually by above licensee, Virginia Martinez. LPA conducted an unannounced case management other inspection per licensee’s request to increase capacity up to 14 children. LPA disclosed the purpose of the inspection and was virtually guided on a tour of the Family Child Care Home. Upon entry LPA observed 7 children in care.

Licensee was initially licensed on 10/23/2018 as a Small Family Child Care Home. The Fire Department has inspected the home and granted a fire clearance for 14 and children. Family Child Care Home operates Monday through Friday varied up to 23 hours depending on parent's need and Saturday from 8:00am - 4:00pm. Per licensee she is currently enrolled in the Nutrition program and provides breakfast, morning snack, lunch, afternoon snack and dinner as needed.

This is a single story, four bedroom, four bathrooms, den, back porch, and an attached garage(maintained key locked). Main care is provided in the den and back porch, the living room is utilized for napping and eating. Three of the bathrooms were inspected and approved of use by the children. The off-limit areas include all the four bedrooms, one restroom and the attached garage.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700105
	VISIT DATE: 06/29/2022

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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are age appropriate toys and equipment on the premises. The fireplace is screened. Per the licensee there are no weapons or firearms of any kind in the facility at this time, nor did the LPA observe any weapons during inspection. LPA observed cots, mats and playpen for infant.

The backyard is utilized by the children for outside play and is fenced all around. The outdoor play area was inspected and play equipment was observed to be free of hazards, loose and sharp parts. LPA observed age appropriate toys both inside and outside of the home.

The facility’s fire extinguisher (2A10BC) met the State Fire Marshal standards. The smoke and carbon monoxide detectors was found to be in operable condition. The FCCH annual fees are current. The parent board was reviewed and had all the required forms posted and accessible to parents. CPR/First Aid is current and expires 10/23/2023.

Licensee is reminded with a capacity increase she must have a qualified assistant present whenever she has more than 8 children in care. Licensee was provided with a capacity and ratio handout pertaining to large Family Child Care Homes and the various age groups that can be under care at one given time.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700105
	VISIT DATE: 06/29/2022

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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: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm

Fire clearance was granted according to today's inspection licensee has been approved for a Large Family Child Care Home with a maximum capacity of 14 children at one given time. Provided clarification on capacity: More than 14 children may be enrolled, but the maximum of 14 children under licensee's responsibility per license at one given time, no exceptions. Effective 6/29/22 a large Family Child Care license has been granted.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit were provided during this inspection.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC809 (FAS) - (06/04)

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