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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020041
Report Date: 08/03/2023
Date Signed: 08/03/2023 01:56:06 PM

Document Has Been Signed on 08/03/2023 01:56 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198020041
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/03/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Alejandra MartinezTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced POC (plan of correction) inspection on 08/03/23 at 01:00 p.m. to ensure that the Type A deficiency cited on 06/29/23 has been cleared. LPA met with Alejandra Martinez, licensee who guided analyst on a tour of the facility. Present during this inspection was the Licensee's assistant. There were 05 children present during this inspection. The following was observed:

- The report and notice of site visit issued on 06/29/23 was posted on the entryway.
- LIC 9224 Acknowledgment of Receipt of Licensing Reports was signed and placed in children's file.
- Licensee is in compliance with the limitations of her license.

LPA cleared deficiency on this date and LPA issued POC clearance letter during the visit.

At this time, the licensee is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

A notice of site visit 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 Licensee, Alejandra Martinez. Appeal Rights were provided.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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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