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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198021094
Report Date: 03/08/2023
Date Signed: 03/08/2023 01:31:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2023 and conducted by Evaluator Monique Jessica Ayala
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20230308084754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198021094
ADMINISTRATOR:MARTINEZ, YENYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 335-9292
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:14CENSUS: 2DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Yeny Martinez, LicenseTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Admissions Agreement: Licensee did not ensure that day care child was picked up from school.
INVESTIGATION FINDINGS:
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On 03/08/2023, Licensing Program Analysts (LPAs) Monique Ayala and Mary Silva conducted an announced complaint investigation for the above allegation. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with licensee, Yeny Martinez who guided LPAs on a tour of the faclity. Also present in the home was licensee's assistant Lucia Martinez. LPAs observed 2 children in care.

During this investigation LPAs interviewed licensee, reporting party and obtained a copy of the facility roster.

Licensee did not ensure that day care child was picked up from school- Reporting party alleged that the licensee did not pick up Child #1 (C1) from school on 03/07/2023. Per licensee, on 03/07/2023 she was unaware that C1 had early dismissal the entire week. Per licensee, she thought early dismissal was only on 03/06/2023. Based on interviews conducted the above allegation is deemed SUBSTANIATED. A Type B deficency is being cited in accordance with Title 22 Regulation, 102419(d)(2).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 33-CC-20230308084754
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 198021094
VISIT DATE: 03/08/2023
NARRATIVE
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An exit interview was conducted and a copy of this report was provided to the licensee along with Notice of Site Visit and Appeal Rights.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20230308084754
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 198021094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
102419(d)(2)
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Admission Procedures and Parental and Authorized Representative's Rights: At the time of acceptance of each child into care...Whenever a parent or authorized representative makes a request pursuant to Section 102419(a)(8), the licensee shall note, date, and initial the request in
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Licensee will ask parents in advance to give the licensee a daily update if their child needs to picked up and what time. Licensee will also add school calander to children's file.
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the child’s file... This requirement was not met as evidence by: based on interview with licensee, C1 was not picked up from school. This poses a potential health and safety risk to children 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.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3