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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629031
Report Date: 08/23/2022
Date Signed: 08/23/2022 04:15:44 PM

Document Has Been Signed on 08/23/2022 04:15 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MARTINEZ, KRISTAN KARISSA FAMILY CHILD CAREFACILITY NUMBER:
376629031
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Kristan Karissa Martinez, LicenseeTIME COMPLETED:
04:15 PM
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On August 23, 2022, at 2:15 PM, Licensing Program Analyst (LPA) Marie Hernandez conducted an unannounced annual inspection with the Licensee Kristan Karrisa Martinez. The purpose of the inspection is to ensure that the home complies with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present during the inspection are four children with the Licensee and the adult helper, Aailyah Nunez. The operating hours are Monday through Friday from 7:30 AM to 5:30 PM.

This is a one story three bedroom, two bath home that was toured and inspected to ensure the environment is safe for the care and supervision of children. The home does not have any bodies of water as per LPA's observation during the inspection. The following areas are used for childcare: Day care room, hallway bathroom and a portion of the backyard. The following areas are off limits: Kitchen, dining room, living room, bedrooms #1, #2, #3 including the attached master bathroom, garage, laundry room and a portion of the backyard. They are made inaccessible to day care children through the use of locks and child safety gates. The Licensee is utilizing a portion of the backyard for outdoor activities of children. The Licensee stated it is understood that there must always be direct supervision while outdoors with the children. The Licensee stated there are no weapons or firearms in the home. The fire extinguisher, smoke detector and carbon monoxide detector meets the requirements and are operational. All poisons, cleaners, and hazardous items in the home are inaccessible to children through latches, locks, and/or placed on high surfaces. The children’s toys and play equipment are available. The required documents are posted. The Licensee has completed the Eight Hours of Preventative Health. Pediatric CPR and First Aid certification expires on 01/09/2023. The Mandated Reporter AB1207 training certification expires on 04/08/2023; it must be renewed every two years prior to expiration date. The immunization records as per SB792 are incompliance. The last fire/disaster drill was conducted on 06/17/2022. The child roster has been maintained. The Licensee was advised that no changes should be made to the home without prior notice and/or approval from Licensing. The Licensee states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes. The prohibited devices were discussed and the Licensee stated it is understood.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE
FACILITY NUMBER: 376629031
VISIT DATE: 08/23/2022
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The Licensee currently does not plan on providing IMS to clients. 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. 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 the publication: Commonly Asked Questions about Family Child Care and the ADA, available at: http://www.ada.gov/childqanda.htm.

The Licensee 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, 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.

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

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.

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.

An exit interview was conducted and the report was reviewed with the Licensee, Kristan Karissa Martinez.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE
FACILITY NUMBER: 376629031
VISIT DATE: 08/23/2022
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On 07/15/2022, the Department received an application/request from the Licensee for an increase of capacity to a large day care. On 08/17/2022, the fire marshal granted the fire clearance. During the inspection today, LPA observed that the home has ample space for a large day care of 14 children. The ratio handout was discussed and provided to the Licensee. Maximum capacity (when there is an assistant present): 12 - no more than 4 infants. Capacity of 14 - No more than 3 infants, 1 child in kindergarten or elementary school and 1 child at least age 6. When there is no qualified assistant, the capacity reverts back to the requirements of a small family child care home. The Licensee stated it is understood. Effective today (08/23/2022), the Licensee is approved for a large day care. An updated license to reflect this change will be sent to the Licensee.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
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