<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019677
Report Date: 09/28/2021
Date Signed: 09/28/2021 01:14:44 PM

Document Has Been Signed on 09/28/2021 01:14 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198019677
ADMINISTRATOR:LORENA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3234274708
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Lorena Martinez, LicenseeTIME COMPLETED:
01:25 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
 On Tuesday, September 28, 2021 at 10:45 AM, Licensing Program Analyst (LPA) Mayra Rivera and (LPA) Rita Ramos conducted an unannounced case management inspection and met with Licensee Lorena Martinez who guided LPA Rivera and Ramos on a tour of the facility.

During the inspection, no children were present. Family members residing in the home has been discussed with licensee and are cleared. Operating hours are Monday to Sunday, 12:00 AM to 11:59 PM and care for children ages 0 to 12 years.

This facility is a one-story home that consists of three bedrooms, two bathrooms, kitchen, living room, front and backyard (fenced and gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera and Ramos; living room, kitchen, bathrooms, bedroom # 2 and # 3 and front yard. Areas off limits to children include- Master bedroom and the backyard is temporarily off limits due to work being done.

At approximately 10:55 AM LPA Rivera and Ramos entered the facility to inspect for safety, comfort, cleanliness, ventilation and working phone. LPA's observed an orange tag dated 3/2/2018 on the heater showing the heater is turned off and not in use. LPA's observed the furniture and children materials to be in good condition and age appropriate.

At approximately 11: 01 AM, LPA Rivera entered the restroom and observed the toilet, hand washing sink, running water, no paper towels, hand soap. LPA observed the bottom cabinets closed and with a child proof lock in place making it inaccessible to children to open cabinet doors. LPA observed the restroom to be in good condition. LPA Rivera advised to place paper towels for hand dry.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019677
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
At approximately 11:29 AM LPA's observed cleaning compounds items stored inside the bottom kitchen sink. LPA observed child proof locks in place making it inaccessible to children to open the cabinets and drawers . For drinking water, Licensee stated she provides water bottles. Licensee provides meals and LPA's observed the refrigerator to be stocked with plenty of food.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has no pets, bodies of waters, firearms, weapons or poisons. LPA's did not observe firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 11:31 AM LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged. LPA did not observed a serviced tag nor purchased receipt. LPA's informed licensee it is a requirement for the extinguisher to be serviced annually or purchase a new one. LPA observed the smoke detector and carbon monoxide in the living room and Licensee pressed on the detector and LPA's heard the sound. The smoke and carbon detectors are in good condition. LPA also observed first aid kits in the kitchen.

At approximately 10:45 AM, LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. Licensee stated the backyard is currently off limits due to work being done. Licensee is currently utilizing the front yard for outdoor play. LPA observed play equipment to be in good condition and age appropriate. LPA observed the front and driveway gate with no latches nor locks to prevent children from opening the gates. LPA observed the medal chain fence located on the driveway ends sticking out. LPA informed licensee the dangers such as tripping hazard, cuts, or pock . LPA also observed an aloe vera plant and advised to place a barrier around to avoid children touching or getting poked. Also LPA observed an opening on the wall and a wood board to closed off the opening wall. LPA informed the wood board can be easily be removed by a school age child and advised to place a proper barrier.

LPA observed licensee Pediatric First Aid/ CPR certification with expiration date 4/2023. Licensee has proof of immunization against Pertussis, MMR and Influenza declination. Licensee has completed the health and safety training on 5/13/1` and mandated reporter (AB 1207) training on 3/2/21. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019677
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
The following was discussed
Safe Sleep: LPA discussed the safe sleep regulations with licensee Lorena Martinez 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 Lorena Martinez of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at also explained to licensee that car seat, stroller are only and only for https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.



Medication: 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

Criminal Record Statement: Licensee Lorena Martinez 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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Lorena Martinez.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/28/2021 01:14 PM - It Cannot Be Edited


Created By: Mayra Rivera On 09/28/2021 at 12:30 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: 198019677

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2021
Section Cited
CCR
102417(g)(1)

1
2
3
4
5
6
7
Operation of a Family Child Care Home
The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire


1
2
3
4
5
6
7
Per Licensee, will have the fire extinguisher serviced or purchase a new one by 10/12/2021
8
9
10
11
12
13
14
extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This regulation was not met by: LPA did not observed a serviced tag nor purchased receipt on the fire extinguisher. This poses a potential health, safety, or personal rights risk to children in care
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Mayra Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021


LIC809 (FAS) - (06/04)
Page: 4 of 4