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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334809551
Report Date: 07/06/2021
Date Signed: 07/06/2021 01:49:28 PM

Document Has Been Signed on 07/06/2021 01:49 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MARTHA'S VILLAGE & KITCHENFACILITY NUMBER:
334809551
ADMINISTRATOR:ROSA VERDUZCOFACILITY TYPE:
830
ADDRESS:83-791 DATE AVENUETELEPHONE:
(760) 347-4741
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY: 23TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Ana Carolina Torres/ Maria Beltran QuinteroTIME COMPLETED:
02:00 PM
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On date and time listed above, Licensing Program Analysts (LPAs) Blanca Ruiz-Silva and Samuel Lopez conducted a required annual inspection as part of a compliance review. A tour of the inside and outside of the facility was granted and the following was observed and discussed with Administrative Assistant, Ana Carolina Torres:
This is a combination center and the other licensed programs were inspected on this date.

· A review of the staff records and a sampling of the children's records was conducted as part of this evaluation.
· The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report - update obtained during inspection
2. LIC 610 Emergency & Disaster Plan- update obtained during inspection
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility (update requested during inspection)
· The following items have been posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu
· The facility is operating within the terms of the license
· Ratios were met during this inspection
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MARTHA'S VILLAGE & KITCHEN
FACILITY NUMBER: 334809551
VISIT DATE: 07/06/2021
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· Appropriate supervision was provided during this inspection- LPA provided PIN 20-24-CCP to licensee during this inspection. - Please see LIC809D-LPA discussed PIN and addressed question regarding new regulation.
· Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: labored breathing; signs of distress; flushed skin color; increase in body temperature and restlessness.
· Staff shall document and update the infant's Individual Infant Sleeping Plan [LIC 9227 (3/20)] and if Section C is not complete, then staff shall return the infant to their back for sleeping.
· Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan (LIC9227). Documentation shall include the following: Date; Infant's name; Time of each 15-minute check; Initials of person who conducted each check.
· If staff observes labored breathing or signs of distress…staff shall obtain emergency medical treatment and immediately notify the infant's authorized representative.
· Staff shall place infants up to 12-months of age on their backs for sleeping.
· An infant shall not be swaddled while in care.
· The facility shall have an individual feeding plan for each infant.
· The facility shall ensure that each infant has an Infant Needs and Services Plan
· The facility shall ensure that staff being utilized as infant teachers during the compliance review meet the qualification requirements.
· Rooms are physically separated from other components
· Rooms are equipped with age appropriate furniture and equipment in good condition
· Activity areas are physically separated from all other components at this center
· Drinking water is provided in both the indoor and outdoor activity areas by ** **Water jugs and cups.***
· Napping equipment is sufficient for capacity and meets licensing requirements.
· Rooms are clean and free of hazards
· No weapons stored at the facility
· There are no bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored where inaccessible to infants
· Hazards are stored where inaccessible to infants
· Toxins are locked
· Toileting area was observed to be safe, sanitary and in operating condition
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MARTHA'S VILLAGE & KITCHEN
FACILITY NUMBER: 334809551
VISIT DATE: 07/06/2021
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· Outdoor play area is physically separated by appropriate fencing and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· There is sufficient cushioning material under high climbing equipment, swings, slides and similar equipment - LPAs observed rubber mat under infant play structures damaged. Please see LIC 809D
· Food preparation area is clean and free of vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste have tight-fitting covers that are kept on, and in good repair
· Individual feeding plans were reviewed
· There is an individual feeding plan for each infant as required- Please see LIC 809D
· Infant needs and services plans were reviewed- Please see LIC 809D
· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid which expires on 03/04/2022
· Opening and closing staff member’s CPR/First Aid expires on 03/04/2022
· Director completed Health and Safety Training on file
· Staff qualifications were reviewed – health screening is on file and all staff meet educational requirements
· Children’s files were reviewed – Identification and Emergency contact information is on file along with a medical assessment
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov, and
· A review of staff records on 07/06/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· Facility is not currently providing IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided an updated Plan of Operation that includes 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
· For more information on SIDS and Safe Sleep Environments, please visit:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MARTHA'S VILLAGE & KITCHEN
FACILITY NUMBER: 334809551
VISIT DATE: 07/06/2021
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California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

See LIC 809D for deficiencies cited.

The following was also reviewed and discussed:
v- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
v- AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses.
v- SB 792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1596.7995(a)(1) - a person shall not be employed or volunteer at a child care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination, they must do so between August 1 and December 1 of each year.
v- AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed, and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MARTHA'S VILLAGE & KITCHEN
FACILITY NUMBER: 334809551
VISIT DATE: 07/06/2021
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vNOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
vEffective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
vAB2370 – Lead Exposure, day care facilities, effective January 1, 2019 - An act amending Sections 1596.866 and 1596.8661 and adding Sections 1596.7996 and 1597.16 to the Health and Safety Code for the education of risks and effects of lead exposure in child care facilities and for the testing of drinking water in licensed child care centers. Licensed providers have access to a document regarding lead toxicity prevention created in partnership with the California Department of Public Health (CDPH) to provide to parents/guardians of newly enrolled or reenrolled children with information on the following:
· Risks and effects of lead exposure
· Blood lead testing recommendations and requirements
· Options for obtaining blood lead testing, including any programs that offer free or discounted tests
This printable document (Lead Poisoning Facts) is located here as well as on the Child Care Licensing website. The bill also requires that that the Department add instruction on the prevention of lead exposure to the Preventative Health and Safety Training curriculum for providers licensed on or after July 1, 2020. Finally, it requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test. The Department must adopt regulations in consultation with the State Water Resources Control Board for the implementation of the requirements for the testing of drinking water for lead in Child Care Centers by January 1, 2021. The regulations shall include requirements to ensure the collection and submission of valid water samples.
vAB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021 - An act amending Sections 1596.76, 1596.955 and 1596.956 and adding Section 1596.951 to the Health and Safety Code to address requirements for a single license and extend the period for possible participation in the toddler programs. It requires the California Department of Social Services, in consultation with stakeholders, to adopt regulations on or before January 1, 2021, to create a Child Care Center license to serve infant, toddler, preschool, and school-age children. It also requires, before January 1, 2024, that all Child Care Centers transition to one-center licenses. Access to forms & Regulations for Child Care Centers online at www.ccld.ca.gov.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MARTHA'S VILLAGE & KITCHEN
FACILITY NUMBER: 334809551
VISIT DATE: 07/06/2021
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vAB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022. Further, the bill would require the SSPI to submit a report to the Legislature by January 1, 2021, proposing plans for enhancements to the online portal and inclusive of a comprehensive implementation plan, based on recommendations from the workgroup.

vPlease subscribe at www.childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov


vThe Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).


An exit interview was conducted and during the interview, the licensee, Ana Carolina Torres confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. Appeal rights were provided and discussed. This report must be available for review, upon request, for the next 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2021 01:49 PM - It Cannot Be Edited


Created By: Blanca Ruiz-Silva On 07/06/2021 at 12:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MARTHA'S VILLAGE & KITCHEN
FACILITY NUMBER: 334809551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2021
Section Cited
CCR
101419.2(b)(2)

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Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan( Lic 9227), which is incorporated by reference. This requirement was not met as evidence by:
LPAs review facility files and C1's file did not have an Individual Infant Sleeping Plan of file.This poses a potential risk to the Health, Safety to the children in care.
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Director agrees to provide form to parent(s) and submit proof of correction to the licensing office no later than 07/09/21.
Type B
07/09/2021
Section Cited
CCR
101429(a)(2)(C)

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Documentation shall be maintained in the infant's file and be available to the Department for review. Documentation shall include the following:
CCR 101429(a)(2)(C)3 Time of each 15 minute check.
This requirements was not met as evidence by: LPAs review facility files and C1 did not comply with regulation requirement.
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Director agrees to submit proof of correction to the licensing office no later than 07/09/21.



>>>>This poses a potential risk to the Health, Safety to the children in care.
Type B
07/09/2021
Section Cited
CCR101419.3

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(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.
This requirement was not met as evidence by: During LPAs file review C1, C2 and C3 did not have a current infant needs and services plan in substantial compliance. This poses a potential risk to the Health, Safety to the children in care.
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Director agrees to submit proof of correction to the licensing office no later than 07/09/21.
Type B
07/23/2021
Section Cited
CCR
101238.2(d)(2)

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The surface of the outdoor activity space shall be amintained in a safe condition, and free of hazards. This requirement was not met as evidence by:
During LPAs physical inspection of infants' playground, it was obseved that the cushion material is tearing and present cracks. This poses a potential risk to the Health, Safety to the children in care.
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Director agrees to submit proof of correction to the licensing office no later than 07/23/21.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2021


LIC809 (FAS) - (06/04)
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