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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417871
Report Date: 10/23/2024
Date Signed: 10/23/2024 04:26:19 PM

Document Has Been Signed on 10/23/2024 04:26 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MARTINEZ, LINAFACILITY NUMBER:
274417871
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Lina Martinez TIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva conducted an announced pre-licensing inspection. LPA met with Applicant Lina Martinez and explained the reason for the inspection. The purpose of this inspection is for change of location. Applicant Lina Martinez has been currently licensed at 968 Nantucket Blvd # 103, Salinas CA 93906, facility # 274415995. Present at home was the applicant alone. The Applicant, her husband and her son are the adults residing in the home. There are two children residing in the home, one daughter (10) and son (16) year old. LPA observed a two story home.

Days and hours of operation will be Monday - Friday from 4:00 AM to 5:00 PM. Applicant completed her Preventative Health and Safety Training on 02/20/2021 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 02/06/2025. Applicant completed the Mandated Reporter Training on 01/24/2023 and a copy of the certification is on file. A copy of current TB test, MMR, Tdap, and flu vaccinations for the Applicant are on file.

Applicant rents the home and copy of the Lease Agreement is on file. Because Applicant rents the home applicant submit LIC 9149 Property Owner/Landlord Notification and LIC 9151 Property Owner/Landlord Consent to provide care until eight children and are on file. Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families until she obtains liability insurance in the future.

LPA toured the indoor and outdoor areas of the home with the Applicant. LPA observed the home is clean and orderly. Applicant has a working cellphone. LPA observed the home has a central air conditioning and heating for safety and comfort of the children. LPA observed a covered fireplace in the living room. LPA observed no bodies of water, no weapons and not pets at home. LPA observed the stairs are barricaded. There are toys, supplies, and equipment for the day care children indoors and outdoors. OFF limit areas inside the home include on the first floor: one bedroom, kitchen, and garage. ALL the second floor that include one bedroom, one bathroom and a rest area. LPA observed the laundry area, and the heating system are in the garage. OFF limit areas outside include front yard, left and right driveways. The left driveway is barricade with a locked storage. The right driveway is barricaded with a fenced. The backyard is fenced. Applicant states will use the backyard as play area and outdoor activities. ON limit areas include living and dining room, kitchen, bedroom # 3, one bathroom.

Report Continues in 809-C page 2.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MARTINEZ, LINA
FACILITY NUMBER: 274417871
VISIT DATE: 10/23/2024
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Report 809-C page 2

LPA observed fully charged fire extinguisher 2A10BC, working at least one smoke and one carbon monoxide detector. Applicant understands that prior to making any change related to the on or off limits must be reported to Licensing. Cleaning products, toxic agents, medications, and sharp objects are inaccessible to children these products are in a top cabinet in the kitchen and in a top cabinet in the garage.

LPA reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will not administer any medication to the children at this time. Applicant states that a child will be isolated in cubicle in the middle of the living room if necessary due to illness or communicable disease. Applicant has a First Aid kit.

Forms of discipline applicant will use: Talking with children and redirection. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Supervision of children, capacity options for a small license, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA discussed the requirements of AB 633 with the Applicant. LPA also discussed "Zero tolerance" related regulations with the Applicant.

A review of staff records on 10/11/2024 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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, 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.

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) 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

Report Continues in 809-C page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MARTINEZ, LINA
FACILITY NUMBER: 274417871
VISIT DATE: 10/23/2024
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Report 809-C page 3

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. Entrance Checklist LIC 9280 was provided to the applicant.

LPA discussed the safe sleep regulations with Applicant and, discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

On this date, 10/10/2024 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 addresses. 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 was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare 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/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Lina Martinez in Spanish.



The applicant Lina Martinez was informed that a small Family Child Care Home license will be approved pending on the following:
1) Approval from a manager of the Licensing Program.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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