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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003193
Report Date: 06/16/2025
Date Signed: 06/16/2025 02:05:35 PM

Document Has Been Signed on 06/16/2025 02:05 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTIN FAMILY CHILD CAREFACILITY NUMBER:
198003193
ADMINISTRATOR/
DIRECTOR:		MARTIN, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 917-0798
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/16/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee Lorena MartinTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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Licensing Program Analysts (LPA) Cynthia Reyes conducted an unannounced site inspection Plan of corrections (POC) inspection on this date to ensure the Type A deficiencies cited on 06/10/2025 have been cleared. This inspection is to ensure the health and safety standards as required by the regulations governing child care centers are met. LPA met with Lorena Martin, Licensee who provided a tour of the day care indoors and out.

LPA observed 3 children with the licensee in the day care at the time of arrival. LPA was conducting an inspection at the next door address 818 E. Vine Ave and observed 5 of the licensee's day care children at the unlicensed address with 2 of the Licensees assistants.

LPA observed the following citations listed below have not been corrected.

(Type A) Fingerprint Clearance 1596.871(c)(1)(A): Licensee has 2 assistants without fingerprint clearance.
Licensee had 1 assistant fingerprinted, however she was observed in the day care on this date and her prints have not cleared as of this date. Licensee did not write a declaration to the department regarding her other assistant no longer working at her day care.

(Type A) Staffing Ratio and Capacity 102416.5(a): LPA observed 17 children in care at one time on this date. Licensee is only licensed for 14 children at one time.
Licensee did not submit to the department a list of each child's name that is enrolled, with the days and hours each child is in care on a regular bases. LPA did observe the licensee was in capacity on this date, however some children were observed at the next door unlicensed home.
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 198003193
VISIT DATE: 06/16/2025
NARRATIVE
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(Type A) Staffing Ratio and Capacity 102416.5(d): Licensee assistant was alone caring for 14 of the enrolled day care children in an unlicensed home address, next door from the day care. Again on this date LPA observed both the licensees 2 assistants at the unlicensed home with 4 children.

(Type A) 102402(a)(3) Conduct Inimical: Licensee was not truthful and forth coming regarding the information requested by the department. Licensee was using an Unlicensed address to conduct a secondary area for her day care and would not grant the LPA access to that entire address to inspect. Again on this date children were observed in the unlicensed home and licensee would not allow access to the unlicensed home owned by her son and husband. Per interviews an assistant was able to go into the unlicensed home and locked it on this date.

Based on Licensing staff observations, interviews, and record review, there are Deficiencies being cited on this date. The following deficiency listed on the attached LIC 809-D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety. LPA provided consultation during this inspection.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with and given to Licensee Lorena Martin.

LPA, Cynthia Reyes informed Licensee Lorena Martin, that this report dated 06/16/2025 document(s) (4) Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety or personal rights of a children in care. Also, LPA, Reyes informed Licensee, to provide a copy of this licensing report dated 06/10/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or written statement, must be placed in the child’s file for verification.

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/16/2025 02:05 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 06/16/2025 at 12:24 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 198003193

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2025
Section Cited
CCR
102402(a)(3)

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RECITE: Conduct Inimical: Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.
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Licensee states she will write a declaration in detail regarding usage of the unlicensed home, her over night care, fingerprint of adults and all the children enrolled.
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This requirement is not met as evidenced by:
Licensee did not correct this citation dated 06/10/2025, which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
06/16/2025
Section Cited
CCR102416.5(d)

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RECITE: Staffing Ratio and Capacity(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's
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Licensee states will cease operating her day care out of the Unlicensed home next door to her day care. Licensee states will write a declaration in detail, on how she will ensure she will not use the unlicensed home next door to conduct her day care.
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children under age 10, shall be either. This requirement is not met as evidenced by: Licensee did not correct this citation dated 06/10/2025, which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/16/2025 02:05 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 06/16/2025 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 198003193

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2025
Section Cited
HSC
1596.871(c)(1)(A)

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RECITE: Fingerprint clearance: Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, prior to employment, residence, or initial presence in the facility
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Licensee states one of her assistant no longer works for her and will submit a declaration stating in detail of her no longer working in the day care and the other assistant she will document how she will ensure she is not in the day care until she has proof she is fingerprint cleared
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This requirement is not met as evidenced by: Licensee has 2 assistants without fingerprint clearance. 1 was fingerprinted and was observed in the day care on this date and still has not been cleared. which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
06/16/2025
Section Cited
CCR102416.5(a)

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RECITE: Staffing Ratio and Capacity: (a) 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: Licensee did not correct this citation dated 06/10/2025, which poses an immediate
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Licensee states she will ensure she does not go over her 14 capacity at one time and will send the Department a list of each child's name that is enrolled, with the days and hours each child is in care on a regular bases. For all the children day and overnight care.
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health, safety or personal rights risk to persons in care.
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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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2025


LIC809 (FAS) - (06/04)
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