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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198401432
Report Date: 06/09/2026
Date Signed: 07/01/2026 08:37:59 AM

Document Has Been Signed on 07/01/2026 08:37 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198401432
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, YARISA YFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 281-2659
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/09/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Applicant- Yarisa MartinezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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The Applicant speaks Spanish only. The entire inspection was translated by the Applicants representative- Fatima Castro.
On June 9, 2026, at 9:15a.m., Licensing Program Analyst (LPA) Keneisha Dunlap arrived at the above facility for the purpose of an announced Pre-Licensing inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the home by Applicant- Yarisa Martinez. Per the Applicant, hours of operation will be Monday- Sunday from 12:00 a.m. to 11:00 p.m. The Applicant will serve children ages 0 to 13 years of age.

This is a multi-single family unit two story home. There are 2 bedrooms, 2 bathrooms, living room, kitchen, playroom, fenced front area, and attached garage. Areas of the home used for the main care area are bathroom 1, living room, fenced front area, and playroom. All areas of the home were inspected for cleanliness, health, safety, heating, and ventilation for the children.

Off limits area(s): Bedroom #1, Bedroom #2, Bathroom #2, kitchen, and attached garage.

LPA Dunlap observed an operable carbon monoxide located in the playroom area.


LPA Dunlap observed an operable smoke detector located in the playroom area.

LPA Dunlap observed a 2A 10BC fire extinguisher with a service tag date of 1/21/26 mounted in the playroom area.
LPA Dunlap observed the parent board by the front door of the home. LPA informed applicant of the required Page 1 of 5
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198401432
VISIT DATE: 06/09/2026
NARRATIVE
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department documents that need to be posted:
· Parent's Rights (PUB 394)
· Earthquake Preparedness Checklist (LIC9148)

LPA Dunlap observed Playroom space to have tile floors throughout the space with large rugs on the floor, mounted TV, dramatic play, library, manipulative items, two highchairs, one crib, two playpens, age appropriate toys, and age appropriate tables and chairs. The cots are stored in this area, and the children will nap in this area. There is a door in play area that leads to the garage. There is a doorknob cover making it inaccessible to children. There is a secondary door that leads to the side of the home. There is a doorknob cover making it inaccessible to children in care. LPA observed all furnishings, equipment, and material to be in good condition.

LPA Dunlap observed kitchen which is off limits with retractable mesh safety gate at the entrance of kitchen making it inaccessible to children. The stove has stove knob covers making it inaccessible to children. The knives are stored in high cabinet making it inaccessible to children.



LPA Dunlap observed Bathroom 1, under the sink cabinet with no hazardous items stored in the area with sliding cabinet U-shaped locks making it inaccessible. There is a potty training chair, and a two-step wooden stool near the sink. Bathroom 1 was observed to have hand washing items, toilet paper, and paper towels. The sink and toilet were found to be operable. The Bathroom was free of any floor hazards. Per applicant, items used by residence will be stored in bathroom 2.

LPA Dunlap observed the living room area to have tile floors, sectional couch, and mounted TV. LPA observed all furnishings, equipment, and material to be in good condition.

There is a stairway in the living room area that has a retractable mesh safety gate at the entrance making it inaccessible to children.

LPA Dunlap observed the fenced front area to have artificial grass all throughout the area, two sunshade sails, scooters, bikes, water & sand table, and seesaw. There is a side gate that leads to the side of the house. There is a self-closing gate latch with adjustable spring hinge lock on the opposite side of gate making it inaccessible. LPA observed all furnishings, equipment, and material to be in good condition. Page 2 of 5

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198401432
VISIT DATE: 06/09/2026
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 LPA Dunlap observed all off limits bedroom 1 & 2, and bathroom 2 to have safety knobs on doors making them inaccessible to children in care.

Exposed electrical outlets have covers throughout the home.

The Applicant has a indoor wall mounted unit for mini split air conditioning and heating system HVAC system for ventilation.

The Applicant has a cell phone that they will use. However, the Applicant was reminded that there must be a cell phone left on premises at all times in order for parents to reach facility.

The Applicant will be providing children food. The Applicant was reminded not to serve foods to children who have allergies, and to keep a list posted in the kitchen.

The Applicant stated they do not plan to administer medication at this time.

The Applicant states that when children are sick, they will be placed in living room for isolation.

The Applicant stated there are no firearms in the home.

The Applicant stated that there are no smokers in the home.

The Applicant stated that they will provide transportation.

The Applicant stated that they do have a first aid kit.

The Applicant stated that they do not have any pets in the home.



There is a front home in front of the Applicants resident that has its own separate entrance.
The Applicant was informed by LPA Dunlap they must submit a plan of supervision.

There are no large bodies of water on the premises. Page 3 of 5
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198401432
VISIT DATE: 06/09/2026
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Criminal Record Clearance- FCCH Applicant- Yarisa Martinez 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

APPLICANT RENTS/LEASES THE HOME AND HAS LANDLORD CONSENT: Because the Applicant- Yarisa Martinez rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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) or (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.

Review of records to be maintained- CCC LPA reviewed with Applicant- Yarisa Martinez the LIC 311A, Records to be Maintained at the Facility, for child’s records, personnel records, administrative records, and documents to be posted. Entrance Checklist was provided to the applicant. Review of records to be maintained- FCCH LPA reviewed with Applicant- Yarisa Martinez the LIC 311D, Forms/Records to Keep in your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with Applicant- Yarisa Martinez and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Applicant- Yarisa Martinez of the importance of checking for and removing 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. Page 4 of 5

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198401432
VISIT DATE: 06/09/2026
NARRATIVE
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On this date, 04/23/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant- Yarisa Martinez was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/communitycare-licensing/subscribe and select the Child Care option to receive email communication.

If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Proof of corrections: Plan of Supervision by June 11, 2026.



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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
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