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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400668
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:43:04 PM

Document Has Been Signed on 02/15/2023 12:43 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198400668
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Erika MartinezTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Patricia Medel and Licensing Program Manager (LPM) Karen Chambers conducted an announced pre-licensing inspection on February 15, 2023 at 9:16 AM. This inspection was conducted in Spanish, interpreting provided by LPA. Patricia Medel. LPA met with Erika Martinez, Applicant who guided Analyst on a tour of the facility. Applicant is requesting a small family childcare home license. Per Applicant, operating hours will be Monday - Friday, 6AM to 6PM. Applicant states that she will care for children 6 mos-11 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 three bedrooms, one bathroom, dining room, living room, kitchen, detached garage, front yard (not fenced) and Backyard (fenced). Main care areas include, living room, dining room, one bathroom and back yard. Off limit areas include three bedrooms, kitchen, front yard, and garage. Rooms are made inaccessible with a child lock. The Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Individuals in the home have been discussed and noted.

Areas that will be used by children were inspected for safety, comfort, and cleanliness. LPA observed equipment, toys and age-appropriate materials for children in the main care areas. LPA observed operable telephone service via cell phone. According to the applicant, in the event she leaves and there's child still in care, the assistant will have a cell phone. Applicant stated that she will provide this number to the Department and parents. Facility does have an operable floor heater in the living room that is not barricaded at this time. Facility has ceiling fans for ventilation. Knives, detergents and cleaning compounds that can pose a danger to children are made inaccessible in a locked cabinet and under the kitchen sink. Medications will also stored in a cabinet that will have a lock device age appropriate up to 11 years of age. Per Applicant the kitchen will be off limits to
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400668
VISIT DATE: 02/15/2023
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children except to walk through to get to the outdoor back area. Applicant will install a kiddie gate making the kitchen off limits. LPA observed that the cabinets in the kitchen to have child locks. LPA observe a can of, Raid ant and roach can in the kitchen, which was removed during this inspection to a child locked cabinet. The applicant was advised that any poisons must be locked, not only inaccessible. Children will nap on cots in the main care area which is the living room/dining room..
During this inspection one small dog was observed. According to the applicant, will be kept in a bedroom that is off limits to the children while the day-care is in session.. Applicant says there are no firearms or weapons stored in the home.

LPA observed that the Applicant has a 2A10 BC fire extinguisher in the home, with a service tag of October 5, 2022. The dual Smoke/Carbon monoxide detector was tested and operable.


The Applicant states that she will provide food for children in care. LPA reminded Applicant that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated. Applicant was reminded that she shall be present in the home and ensure children are supervised at all times. If Applicant temporarily leaves the home she must ensure a substitute adult with required training and documents supervise the children in her absence.

The Applicant has completed the required Health and Safety Training, Pediatric First Aid and CPR and Mandated Reporter Training. Applicant has proof of immunization against measles, pertussis and flu declination on file and cleared for TB.

Applicant states that they plan on caring for infants 6mos to 11 yrs of age.

LPA informed applicant of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and the 15 - minute sleep check documentation for infants 0-24 months. Applicant states the following sleep supervision plan for infants: Infants will nap in the main care where applicant supervises them at all times.

Outdoor play area is located in the backyard. LPA observed that the backyard is fenced and free of hazards. The outdoor play area has equipment, toys and age-appropriate material for children. However, there was one jumper that needs handles to be tightened. LPA did not observe any pool, spas or bodies of water on

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400668
VISIT DATE: 02/15/2023
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the premises. Detached garage was observed to be away from play area for children and inaccessible to children by distance and a locked door.

LPA discussed latest COVID-19 precautions and procedures with Applicant. Applicant states that temperature checks will be done at drop off, hand washing, and disinfecting of highly touched areas. Isolation area for sick children waiting to pick up by a parent will be located in the bedroom, away from other children. Capacity was discussed with applicant and handout provided.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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-sleephttps://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.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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 reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Wet signature captured during inspection due to printing issues.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400668
VISIT DATE: 02/15/2023
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
The following corrections need to be corrected prior to obtaining a small family child care license.
Corrections are due by 02/29/23

· Applicant will install an anchored barricade for the wall heater located in the main room where children exist.
· Applicant will remove 4 large screws from the cement located next to the stairs that children would use to get to the back yard play area.
·Applicant will add hand rails to the stairs both right and left so children can hold on when going down the stairs.
·Applicant will replace child safety locks with key locking device due to age of children to be cared for. ······A ·Applicant will install a kiddie gate to prevent access to the kitchen
·Applicant removed Pothos plants and placed outside in the front yard.
·Applicant removed chair that foam was exposed and threw in the trash.
·Applicant removed Raid can and stored in locked cabinet high up inaccessible to children.
·Applicant .removed jumper that needed tightening in the hand rails.


A small family child care licensee will be granted upon receipt of proof of correction for the above and final review of application. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Exit interview conducted and report was reviewed with the applicant, Erika Martinez.

-End of Report

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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