304314043-7-12-2022-06-CC-KDEI-CG5QBE-20220708120125

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314043
Report Date: 07/08/2022
Date Signed: 07/12/2022 02:48:06 PM

Document Has Been Signed on 07/12/2022 02:48 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	MARTINEZ, BRIZA & MARTINEZ, SILVIA		FACILITY NUMBER:	304314043
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	07/08/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicants Ms. Martinez, Briza & Martinez, Silva		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Desai, Ketki conducted an announced in-person Pre-Licensing inspection for a new Small Family Child Care home. LPA met with the Applicants Ms. Martinez, Briza & Martinez, Silvia who provided a tour of the new home. A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Applicant's stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Licensee was reminded if changes, to notify the licensing office. Applicant is requesting a Small family childcare home license. Operation hours will be Monday to Friday 7:00 AM to 6:00 PM and care and supervision shall be provided to children ages 1 months to 14 years only (Infants to School age children) All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story family home with 3 bedrooms, 2 full bathrooms, living room, family room, kitchen with dining area, laundry room, attached garage and back yard with two side yards. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone. Ventilation and heating. There is central heat in the home. Home has ceiling vents for air flow. The A/C unit is side yard ( inaccessible to children) Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children stored in the locked laundry room. Applicant states (that there are no poisons on the premises) and was advised that any poisons must be locked with a key or combination lock. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, BRIZA & MARTINEZ, SILVIA	FACILITY NUMBER: 304314043
	VISIT DATE: 07/08/2022

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Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant's has designated Three bedrooms, one bathroom, kitchen with dining area, laundry area, two side yards and attached garage as off limit areas. Applicant has installed one child safety gate at the entrance of the kitchen from the day care area and the second child safety gate on the kitchen entrance falling in the passage area, making the kitchen, dining, laundry room completely inaccessible to children. Kitchen cabinets have magnetic locks installed on them. All the bedrooms doors and the garage door have child safety knobs installed making them inaccessible to children. Master bathroom is inside the master bedroom which is off limits. The two side yards are made inaccessible by a mesh fencing and a wooden gate on the other side making the side yards inaccessible to children. Designated napping room has a fire place with a child safety gate surrounding the area making it completely inaccessible to children.

Applicant has installed magnetic locks on the bathroom cabinets designated for day care use.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

The applicant shall use the Cell phone for Day care activities and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation.

Applicant was informed and understands the home is to be free from smoking during hours of operation.
Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Parents and children shall enter the home, through the main gate leading into the small passage area into the living room and the family room designated for day care activities. The Family room is designated for day care activities including dining and infant activities while living area is set up for napping activity with infant portable cribs and cots for children. There is a sliding door in the family room which opens into the designated back yard for outdoor activities while sliding door facing the bodies of water is locked and bolted. Both the rooms have age appropriate furniture, toys and educational items. Applicant has covered the wooden floor with thick placement mats.

Older infants, toddlers and preschool age children shall nap on Cots and blankets shall be brought from home, washed on a weekly basis by the parents, while linens are provided by the Applicant. Dining activities shall be held in the day care area, age appropriate table and chairs for the toddlers and preschool age children are arranged and infants shall use high chairs. (2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, BRIZA & MARTINEZ, SILVIA	FACILITY NUMBER: 304314043
	VISIT DATE: 07/08/2022

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Applicant has a small meshed play yard for infants in the corner of the Day care room, with infant toys. Infants shall nap in the napping room with ongoing supervision provided in-between two applicants, changing mat was also observed. All Infant items: diapers / wipes/ lotions and milk shall be provided by the parents. Mother's milk shall be labeled and stored appropriately. Per Applicants infants shall not be left unattended while they are sleeping and desired environment shall be provided to the infants during their napping time.

LPA discussed the Safe Sleep practice with the Applicants, Ms. Martinez Briza & Ms. Martinez, Siliva

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.
Licensee shall maintain LIC 9227 form in the infant file. ( Printed and given to the applicants)

Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

The bathroom is located in the passage area, next to the kitchen, it has small step stool and toddler toilet seat for the younger toddlers. There is a cabinet under the sink with a safety lock installed. The children's bathroom was observed to be safe and free of hazardous items.

Applicant shall provide Breakfast, AM/PM snacks, to the enrolled children. Lunch shall be brought from home in labelled containers and stored accordingly.

Upon entrance through the designated main door of the home, applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines. (3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, BRIZA & MARTINEZ, SILVIA	FACILITY NUMBER: 304314043
	VISIT DATE: 07/08/2022

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Applicant has set up a sanitizing station at the entrance door of the house, on a side table.

OUTDOOR PLAY AREA: Applicant has designated the middle section of the back yard for outdoor activities. It is completely secured and fenced for each end with concrete and artificial turf flooring with shaded patio top. There are age appropriate toys arranged in it .

The Small Family Child care home has Bodies of Water/ Weapons and a Pet in the home.

Applicant has one small outdoor cat as a pet, which shall remain in the off limit areas during hours of operation.

Bodies of Water: Home has a pool in the off limit area, which is surrounded with fences 5 feet in high, the fence does not obscure the pool from view . There is an open space in-between the pool and the designated back yard for outdoor activities. The designated back yard for children has also a mesh fencing 5 feet high , secured to the ground, the fence gate swings away from the pool with a self closing mechanism and a self latching devise located on the top of the gate.

Weapons : Applicant has one weapon in possession, the equipment is stored in the locked box in the bedroom on the top shelf and the firing pins are stored and locked separately in the garage. Both the areas are off limits to the children.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant has mounted the Fire extinguisher on the side wall of the day care room. Smoke & Carbon Monoxide detectors are mounted on the ceiling of the passage area of the home.

Applicants have completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 06/27/2024. There are first aid supplies available.

The following was discussed with the applicant: In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility license. (4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, BRIZA & MARTINEZ, SILVIA	FACILITY NUMBER: 304314043
	VISIT DATE: 07/08/2022

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Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
The fire extinguisher type 2A-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No Johnny jumpers, No Baby walkers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA discussed the following items with the applicants Ms. Martinez, Briza & Martinez, Silvia during the Exit interview:

Criminal Record statement: Applicants Ms. Martinez, Briza & Martinez, Silvia was reminded that all adults 18 and over living or working in the home, 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.
(5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, BRIZA & MARTINEZ, SILVIA	FACILITY NUMBER: 304314043
	VISIT DATE: 07/08/2022

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Safe Sleep : LPA discussed the safe sleep regulations with Applicants Ms. Martinez, Briza & Martinez, Silvia & discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed of the Applicants Ms. Martinez, Briza & Martinez, Silvia 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: 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.

Review of records to be maintained : LPA reviewed with Applicants Ms. Martinez, Briza & Martinez, Silvia 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.

Subscribe to CCLD important information

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 license- 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 improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email 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/process. (6)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTINEZ, BRIZA & MARTINEZ, SILVIA	FACILITY NUMBER: 304314043
	VISIT DATE: 07/08/2022

NARRATIVE

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OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

The facility at the time of Pre-licensing inspection is in compliance for a (Small Family Child Care Home) with Title 22 Regulations. License shall be issued upon Management approval.

Exit interview conducted with the Applicants Ms. Martinez, Briza & Ms. Martinez, Silvia this report was read to the applicant and Appeal rights were presented.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC809 (FAS) - (06/04)

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