376629031-8-14-2024-20-CC-VWIN-D85PPK-20240814112942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629031
Report Date: 08/14/2024
Date Signed: 08/14/2024 11:29:50 AM

Document Has Been Signed on 08/14/2024 11:29 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE		FACILITY NUMBER:	376629031
ADMINISTRATOR/ DIRECTOR:	KRISTAN K. MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 867-2699
CITY:	LA MESA	STATE: CA	ZIP CODE:	91941
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 9	DATE:	08/14/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Kristan Martinez		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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On 8/14/2024, at 9:15am, Licensing Program Analyst (LPA), Vicky Williamson conducted an unannounced annual random inspection. LPA met with Licensee, Kristan Martinez and disclosed the purpose of the inspection. There were nine (9) daycare children present, two (2) of whom are infants. Also present was licensee's assistant Aaliyah Nunez. Days and hours of operation are Monday through Friday, 7:30am - 5:30pm.

This is a one story three bedroom, two bath home. LPA accompanied by licensee toured the inside and outside of the home. The following areas are used for childcare: kitchen, living room, day care room, bathroom #1 (hallway), portion of the backyard (right side). The following areas are off limits bedrooms #1, bedroom #2, bedroom #3, bathroom #2 (inside of master bedroom #3), garage and portion of backyard (left side). Off limit areas are made inaccessible to daycare children through the use of locks, door knob covers, fencing and safety gates. Licensee stated that the right side of the the backyard is utilized for outdoor activities. Licensee stated that the gate located on the right side of the front of the home is used as an entrance for daycare parents. Licensee was reminded that there must always be direct supervision of children during outdoor activities. Licensee updated facility sketch during time of inspection.

LPA advised the Licensee that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change.

The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational. Fireplace located in the living room is properly secured. Poisons, detergents, cleaning compounds, medications and other hazardous items were made inaccessible to children. Licensee has children's toys, play equipment and books available. Licensee has a working cell phone.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE	FACILITY NUMBER: 376629031
	VISIT DATE: 08/14/2024

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Licensee stated that there are no bodies of water on the premises. Licensee stated there are no firearms, other weapons, or ammunition in the home.

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.

Pediatric CPR/First Aid certification for licensee is valid through 1/2025 and for assistant 5/2026. Licensee and assistant have required immunization records on file. Mandated Reporter training certification for licensee is valid through 5/15/2026 and for assistant 5/30/2026. LPA informed licensee to ensure the mandated reporter training is completed once every two years. LPA observed the required documents posted. A sample of children’s files were reviewed and were determined to be complete. The last fire/ disaster drill was conducted and documented on 12/15/2023. Licensee was reminded that fire/disaster drills should be conducted and documented every 6 months.

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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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 reviewed PIN 20-24-CCP regarding Safe Sleep with licensee. Licensees stated that she understood.
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.
See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE	FACILITY NUMBER: 376629031
	VISIT DATE: 08/14/2024

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LPA and licensee discussed and reviewed the following: Report suspected child abuse and neglect, form LIC 311D, maintaining children’s records according to regulation, posting required forms. Licensee is reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided information regarding SIDS, Lead Exposure and Shaken Baby Syndrome.

LPA discussed and provided Licensee with the following: childcare advocates email address: childcareadvocatesprogram@dss.ca.gov. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Please visit the Guardian web page and set-up your Guardian account. https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. If you have any questions regarding Guardian, please contact CDSS at email: guardian@dss.ca.gov.

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.

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. See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINEZ, KRISTAN KARISSA FAMILY CHILD CARE	FACILITY NUMBER: 376629031
	VISIT DATE: 08/14/2024

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Licensee completed the Health and Safety Issues Family Child Care Regulation 102417 form during time of inspection.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, one (1) Type B deficiency is being cited. See the attached LIC 809D.

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

Exit interview conducted and report was reviewed with the Licensee, Kristan Martinez. A copy of this report along with Appeals Rights, were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/14/2024 11:29 AM - It Cannot Be Edited

Created By: Vicky Williamson On 08/14/2024 at 10:50 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, KRISTAN KARISSA FAMILY CHILD CARE	FACILITY NUMBER: 376629031
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in that the last fire/disaster drill was conducted and document 12/15/2024 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/16/2024
	Plan of Correction
1 2 3 4	Licensee stated that she will conduct and document a fire and disaster drill, and submit proof to the San Diego Regional Office, no later than 8/16/2024.

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:

Tulam Vu

LICENSING EVALUATOR NAME:

Vicky Williamson

LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC809 (FAS) - (06/04)

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