198020873-10-22-2021-33-CC-RLOZ-C82PC7-20211022111127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020873
Report Date: 10/22/2021
Date Signed: 10/22/2021 11:11:34 AM

Document Has Been Signed on 10/22/2021 11:11 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	198020873
ADMINISTRATOR:	MARTINEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 948-5620
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/22/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria Martinez, Applicant		TIME COMPLETED:	11:30 AM

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	At 8:30 am Licensing Program Analyst (LPA) Roxana Lopez conducted a pre-licensing inspection today to inspect and evaluate facility for a Family Child Care Home relocation. Applicant is relocating Martinez Family Child Care Home (#198018416) from 6325 Winodee Drive, Pico Rivera, CA 90660, to this new location. A risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Maria Martinez, applicant who guided licensing staff on a tour of the facility. Per applicant, family members residing in the home are 2 adults and no children. The applicant is requesting a relocation on her large family child care home license. Per applicant, operation hours will be Monday to Friday, 6:00AM to 6:00PM Applicant states that she will care for children 0-12 years of age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 3 bedrooms, 2 restrooms, living room, den, kitchen, garage, front and back yard (which is fenced and divided in two) Per applicant, the children will use 1 restroom, 1 bedroom, living room, den, kitchen and backyard. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service via cell phone, ventilation and heating. Home has central air and heat. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states that there are no poisons on the premises. Applicant was advised that any poisons must be locked with a key or combination lock. Licensing staff observed a fireplace in the den and a wall heater in the living room which are both inaccessible for children in care. ------------------------------------------------- Pg, 1 of 5 ----------------------------------------------------------

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020873
	VISIT DATE: 10/22/2021

NARRATIVE

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Based on the Facility Sketch submitted, areas off limits to children and parents are: 2 bedrooms, 1 bathroom, front yard, garage and half of the back yard which is fenced. There is a security knob on the bedroom doors and on the bathroom door. The half of the backyard that is not used by children has a locked fence making it inaccessible. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

OUTDOOR PLAY AREA
The children will use the back yard for outdoor play, which is divided in two and was observed to be fenced. Licensing observed that the half off limits backyard is inaccessible by a locked white fenced. The area that the children are using was observed with not toys or equipment for children to play with. Per applicant she will bring the toys from the other home and submit pictures when the yard is set up.

Per applicant, there are no pets, firearms, weapons or bodies of water on the premises. LPA did not observed any bodies of water.

The valve on the 2A10BC or larger fire extinguisher indicates fully charged and was last serviced on 8/9/2021 as indicated on the service tag. Smoke and carbon monoxide detectors were tested and are operable.

There are toys available for children, to use- Per applicant she has more toys and materials that she is adding once she is licensed in this home

The applicant states that they will provide food for children in care.

The applicant has completed the required Health and Safety Training including Nutrition and Lead Training. Applicant and Assistant have current Pediatric First Aid and CPR. There are first aid supplies available.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020873
	VISIT DATE: 10/22/2021

NARRATIVE

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At 10:00 am the following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020873
	VISIT DATE: 10/22/2021

NARRATIVE

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· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Infant Care: Applicant states that they will care for infants. LPA discussed the safe sleep regulations with applicant 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 applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at 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 provided applicant with the LIC 9227 Individual Sleeping Plan

Incidental Medical Services (IMS): 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

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

At 10:05 AM LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. All required forms listed were explained and provided to the applicant during this visit.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020873
	VISIT DATE: 10/22/2021

NARRATIVE

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Licensing staff consulted with licensing regarding COVID-19 health and safety guidelines on this date, Per applicant she will be bringing the COVID-19 posting from the other home to this one once it is licensed. A RAST inspection is on file. During this inspection LPA discussed Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Based on licensing staff observations, the following corrections need to be corrected prior to obtaining a large family child care license. Corrections are due 10/25/2021 .

• Applicant states that she will set up the back yard with toys and equipment necessary to have the outdoor area ready for them. Applicant states that she will submit a picture as proof of correction.
• Applicant states that she will add all the COVID posting in the home. Applicant states that she will submit a picture by due date as proof of correction.

Once corrections The application will be submitted for final review to the department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

At 10:45 am Exit interview conducted and report was reviewed with the licensee Maria Martinez.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

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