<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628543
Report Date: 12/11/2024
Date Signed: 12/11/2024 12:30:03 PM

Document Has Been Signed on 12/11/2024 12:30 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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MARTINEZ, MICHELLE FAMILY CHILD CAREFACILITY NUMBER:
376628543
ADMINISTRATOR/
DIRECTOR:		MICHELLE MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 862-1037
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/11/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Michelle MartinezTIME VISIT/
INSPECTION COMPLETED:
12:35 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
On 12/11/2024 at 9:00AM, Licensing Program Analyst (LPA) Saul Zazueta and Licensing Program Manager (LPM) Jason Garay conducted an unannounced Annual inspection with Licensee, Michelle Martinez. LPA disclosed the purpose of the inspection and was led on a tour of the facility, both indoors and outdoors. This facility is a one-story, four (4) bedroom, two (2) bathroom house. The following areas are used for childcare: living room, dining room, kitchen, and detached casita which includes day care bathroom and day care room. Off limits areas include bedroom #1, bedroom #2, bedroom #3, bathroom #1, garage, south half of backyard, and two sheds located in the rear of the premises. Off limits areas are inaccessible to children by use of safety gates, safety latches and pad locks. Days and hours of operation are Monday through Friday, 7:30AM to 5:00PM. There were four (4) children present and licensee’s spouse, who assists in providing care, during the inspection.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements and were observed to be operational. LPA informed licensee that detergents, cleaning compounds, medications and other hazardous items shall be made made inaccessible. LPA observed multiple bottles of prescription and over the counter medication located on the kitchen counter and dining room table, which were accessible to children in care. LPA also observed a knife block with knives on the kitchen counter, and bottles of sunblock and listerine located under the daycare bathroom cabinet, which were also accessible to children in care. LPA explained that poisons should be placed in a storage area and locked. LPA observed bottles of insecticide in the unlocked shed located in the backyard that was accessible to children. During the inspection, LPA did not observe children in or around the areas which contained hazardous items. North half of backyard, which is divided by a white picket fence, is used for outdoor activities. LPA informed licensee to ensure that children are supervised at all times during outdoor activities. There is no fireplace in the home. LPA observed a wall heater, which was securely screened. Licensee has children's toys, play equipment and books available. Licensee has a working cell phone. Licensee stated that there are no firearms, other weapons, or ammunition in the home.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376628543
VISIT DATE: 12/11/2024
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
26
27
28
29
30
31
32
Licensee resides in a house, which has an aboveground jacuzzi located in the south half of the backyard. The backyard is divided by a white picket fence, approximately three to four feet high. The south half of the backyard is kept off limits by a gate and padlock which was unlocked at the time of inspection. The jacuzzi was full of water and has a cover that does not lock.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. LPA reviewed children’s files. Three out of four children’s files reviewed were complete and met regulations. Child #1 (C1) was missing immunization records.

The Licensee completed 8 hours of preventative health which included nutrition and lead training on 11/09/2019. Licensee’s Mandated Reporter AB1207 training expires on 04/12/2026. Pediatric CPR and First Aid certification expires on 11/21/2025. Licensee has required immunizations, per file review. Required documents were posted during the time of inspection. Facility roster is maintained and was reviewed. The licensee conducted and documented a fire and disaster drill on 06/22/2024. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep. LPA also informed licensee 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376628543
VISIT DATE: 12/11/2024
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
26
27
28
29
30
31
32
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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. LPA reviewed with licensee 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 was provided to the applicant.

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 licensed-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 receive email communication.

On this date, 12/10/2024, 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. LPA discussed California Megan's Law with licensee and provided: www.meganslaw.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376628543
VISIT DATE: 12/11/2024
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
26
27
28
29
30
31
32
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.

Per California Code of Regulations, (Title 22, division 12 & Chapter 3) one (1) Type A citations, one (3) Type B citations are being cited on the attached LIC 809-D.

LPA, Saul Zazueta, informed Licensee, Michelle Martinez, that this report, dated 12/11/2024, documents one (1) Type A citation(s), which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA, Saul Zazueta, informed the Licensee, Michelle Martinez, to provide a copy of this licensing report dated 12/11/2024 that documents Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the Licensee, Michelle Martinez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

An exit interview was conducted, and this report was reviewed with Licensee, Michelle Martinez.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 12/11/2024 12:30 PM - It Cannot Be Edited


Created By: Saul Zazueta On 12/11/2024 at 11:37 AM
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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376628543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in that the jacuzzi had a cover without locking devices installed, rendering it accessible which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/11/2024
Plan of Correction
1
2
3
4
During the inspection, a majority of the water was removed and licensee stated that they will send a photo of the completely empty jacuzzi to the San Diego Regional Office (SDRO) within 24 hours for review. Licensee also stated that they will install the attached locking devices on the jacuzzi cover within 30 days and notify the SDRO once complete.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 12/11/2024 12:30 PM - It Cannot Be Edited


Created By: Saul Zazueta On 12/11/2024 at 11:37 AM
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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376628543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in that medicines, cleaning compounds, and detergents were found accessible to children in the kitchen, dining room, and daycare bathroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
1
2
3
4
During inspection, LPA observed licensee make medication located on the kitchen counter and dining room table innaccessible to children in care. Licensee stated that they will make bottle of Listerine and sun block in the daycare bathroom innaccessible to children in care by installing safety latch on the daycare bathroom cabinet. Licensee stated that they will send the SDRO a picture of secured cabinet by 12/20/2024.
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that poison was found in an unlocked shed located in the backyard, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
1
2
3
4
Licensee stated that they will install a pad lock on the shed containing poisons and send the SDRO a picture of secured shed by 12/20/2024.
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:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2024


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 12/11/2024 12:30 PM - It Cannot Be Edited


Created By: Saul Zazueta On 12/11/2024 at 11:37 AM
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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376628543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that one out of four children files was missing immunization records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
1
2
3
4
Licensee stated that they will obtain copies of C1's immunization records and submit copies to the SDRO by 12/20/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2024


LIC809 (FAS) - (06/04)
Page: 7 of 7