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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021094
Report Date: 03/08/2023
Date Signed: 03/08/2023 10:28:26 AM

Document Has Been Signed on 03/08/2023 10:28 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 CAREFACILITY NUMBER:
198021094
ADMINISTRATOR:MARTINEZ, YENYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 335-9292
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
03/08/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Yeny Martinez, LicenseeTIME COMPLETED:
10:45 AM
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On March 8, 2023, Licensing Program Analysts (LPAS) Monique Ayala and Mary Silva conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with licensee who guided LPAs on a tour of the facility. Also present in the home was licensee's assistant Lucia Martinez. LPAs observed 2 children in care.

The purpose of the inspection is to conduct a health and welfare check to ensure the health and safety of the children in care is met. LPA's reviewed children files and found the files to be complete.

Licensee does not have a current facility roster.

LPA's provided consultation and the licensee was given a Technical Violation for not having a recent facility roster.

An exit interview was conducted and a copy of this report was provided to licensee, Yeny Martinez 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
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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