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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021032
Report Date: 12/07/2023
Date Signed: 12/07/2023 10:35:10 AM

Document Has Been Signed on 12/07/2023 10:35 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198021032
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 1DATE:
12/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Claudia Martinez, LicenseeTIME COMPLETED:
10:50 AM
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On December 7, 2023, Licensing Program Analysts (LPAs) Staicy Perry and Monique Ayala conducted a case management - licensee initiated inspection. A COVID-19 risk assessment was conducted. The home is currently licensed for 8 children and a request for a capacity of 14 children was received. All areas identified on the facility sketch were toured. Hours of operation are Monday through Friday 6:00am to 6:00pm. Licensee states she is working with children ages 0 months - 12 years old. LPAs observed a census of 1 children in care during the visit.

The facility has requested an increase of capacity from 8 to 14 on 10/24/2023. Fire clearance was granted on 11/15/2023. Capacity Increase will be granted, pending final file review. License will be amended to reflect new capacity of fourteen (14) children. Increase is contingent upon a Licensing Program Manager review and approval.

The day care area is provided in the living room, kitchen and bathroom and front yard.

The LPA inspected the facility and found the facility to be clean and safe. telephone service was verified. Heating, lighting, and ventilation are adequate. LPA observed age-appropriate toys and materials.

LPA reviewed infant safe sleep regulation and ratios with licensee. A copy of the Safe Sleep Regulation was provided to the licensee along with Safe Sleep Plan LIC9227. LPA provided recall website, https://www.cpsc.gov/Recalls. Licensee was provided a sample of the 15-minute sleep log.



Carbon/Smoke Detectors were tested and found to be operable. There is currently a fire extinguisher with a service date of 5/11/2023.
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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198021032
VISIT DATE: 12/07/2023
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Licensee’s CPR/1st Aid will expire 2/25/2025 and Mandated reporting Certificate will expire 5/11/2024.

LPAs reviewed if there are any weapons or pets, licensee states there are firearms in the home. LPAs observed the firearms to be stored in accordance to title 22 regulations. LPAs obtained photographs of firearms. Licensee stated that she has no pets and LPAs did not observe any, however her front neighbor does have 1 big dog. There were no Bodies of Water observed on the premises. LPAs provided an Unusual Incident Report (UIR) and reviewed regulations of self-reporting. Cleaning products are kept in the kitchen under the sink with a child proof lock. No children are currently on medication, but Incidental Medical Services (IMS) policy was discussed.

Licensee states that she is in the process of hiring an assistant.

A notice of site visit was given to licensee and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Claudia Martinez.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
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