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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005559
Report Date: 08/18/2021
Date Signed: 08/19/2021 11:07:43 AM

Document Has Been Signed on 08/19/2021 11:07 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MARTINS, MEIRE R.FACILITY NUMBER:
214005559
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/18/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Meire Rosa MartinsTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPA) Haydee Caliboso met with Meire Rosa Martins for a change of location pre-licensing inspection of the home on 8/18/21. The applicant and the adult living in the home have been fingerprinted and all cleared.

The applicant is renting the home, which is a two-level home with 3 bedrooms and two-bathrooms. The applicant lives with her two sons, ages 9 and 18 years old. The hours of operation are Monday through Friday, 8:00AM to 5:30PM. The facility will provide care for children between birth to 12 years old. During the inspection, capacity and ratio requirements were discussed and reviewed with the applicant. There is proper lighting and ventilation in the home, a working telephone, fully functioning smoke and carbon monoxide detectors, and a fully charged 2A10BC fire extinguisher. Applicant’s home is clean, orderly, and equipped with age-appropriate materials and books available for children. LPA observed there are no baby walkers, bouncers, or exersaucers in the home.

Childcare will be provided in the following areas: living room, dining room, living kitchen, and kitchen nook, hallway bathroom on the 2nd floor, and upper backyard playground. The backyard is fully fenced and gated. LPA reminded the licensee that active supervision must be observed at all times when children are present in the bathroom on the 2nd level of the home. The living room will be used for napping children. Kitchen nook will be used as isolation area for ill children. All bedrooms in the 2nd level of the home will remain locked when children are present.
Cont. 809 pg. 2
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINS, MEIRE R.
FACILITY NUMBER: 214005559
VISIT DATE: 08/18/2021
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Off limit areas: 2nd level of the home, including all bedrooms, laundry room, and garage. The stairs in the home is gated. All cleaning supplies, detergents, and toxins are stored in a locked cabinet made inaccessible to children. Kitchen knives and sharp tools are stored and locked in a cabinet where they are made inaccessible to children. Applicant will provide meals and snacks for the children. There is no body of water such as a swimming pool, spa, hot tub, or fishpond in the home. The home has a fireplace in the living room which have been barricaded. There are no weapons or firearms in the home. All areas that are off-limits are made inaccessible to children.

The LPA reviewed and discussed all necessary requirements to administer medical treatment. The applicant will administer medications to children. LPA reviewed and discussed isolation of sick children. Positive redirection will be used for discipline. The applicant was reminded there are no walkers, exersaucers, jumpers, bouncers or any similar items to be used for children in care and shall be made inaccessible. LPA informed the applicant that emergency drills will be conducted at least once every six months and drills must be properly logged.

The applicant's First Aid/CPR certificate expires in 2023. LPA discussed facility ratios and capacities with the applicant. Applicant is advised all adults, 18 years and older living in the home, helper, or assistant must have obtain a TB clearance, a criminal record clearance and must be associated to the facility by submitting an LIC 9182 form with a copy of CA Driver's License or CA ID prior to having any contact with children in care.

Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.
Cont. 809 pg. 3
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARTINS, MEIRE R.
FACILITY NUMBER: 214005559
VISIT DATE: 08/18/2021
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Applicant was informed about the Provider Information Notices (PINs) on CCLD website. A copy of A Child Care Provider's Guide to Safe Sleep and LIC 9227 Safe Sleeping Plan were reviewed and provided during the inspection. This report was discussed and explained to the applicant. Records to be maintained in the facility was discussed and reviewed with the applicant. LPA provided a copy of records to use for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster. Applicant has completed the www.mandatedreporter.ca.com training and a copy is in the file. LPA discussed the effects of lead exposure with the applicant. Resources and materials were sent through email on 8/18/21. LPA encouraged the applicant to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Prior to approval of small family childcare: the applicant shall complete and submit verification of the following:
· First Aid Kit
· Covid – 19 Self-Assessment
· Proof of TB clearance for one adult living in the home


This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov



SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
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