426216798-1-17-2024-17-CC-GNEE-CZ6R9M-20240104114946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216798
Report Date: 01/04/2024
Date Signed: 01/17/2024 04:45:07 PM

Document Has Been Signed on 01/17/2024 04:45 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	426216798
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/04/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Margarita Martinez		TIME COMPLETED:	12:00 PM

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This is to amend the original report dated 1/4/2024 to reflect the correct inspection date.

On 1/4/2024, Licensing Program Analysts (LPAs) German Negrete and Gigi Reyes conducted an announced Pre-licensing inspection for Martinez Family Child Care Home (FCCH) license. LPAs met with Margarita Martinez, Applicant. The purpose of the inspection was discussed and together LPAs and applicant toured the inside and outside of the home. There were no children in care at the time of the inspection.

Applicant requested a small family childcare license. The home is a single story home that consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, garage and outdoor play area that is fenced off. The areas used for day-care are as followed; living room, hall way bathroom and outdoor play area.

The off limits areas consist of (3) bedrooms, (1) bathroom and garage. LPAs observed a safety door knob covers on the bedroom and garage doors making the two (2) bedroom, and garage inaccessible to day-care children. LPAs observed the kitchen to be gated and made inaccessible to children in care. The knives in the kitchen are elevated inside a cabinet making these items inaccessible to children in care.

LPAs observed that the FCCH is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPAs did not observe any toxins nor hazards items accessible to children in care.

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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216798
	VISIT DATE: 01/04/2024

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LPA observed the medication are stored in an elevated cabinet in the kitchen. Cleaning compounds were observed in the garage secured with safety locks and inaccessible. The bathrooms to be used for children in care were observed to be clean and free of toxins. LPAs observed that home is not day care ready due to absence of age appropriate chairs, tables, equipment, toys and other materials for child care activities.

LPAs and applicant toured the outdoor play area. The outdoor play area is completely fenced.

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility There are three (2) adults living in the home, all adults have been fingerprint cleared.

LPAs observed a regulation 2A10BC fire extinguisher in the FCCH at the time of the inspection that was 12/31/2023. Licensee is reminded to service or purchase the fire extinguisher yearly. LPAs observed applicant test the smoke and carbon monoxide detectors in the home at 9:55 AM and were functioning at the time of the inspection.

Applicant stated that there is a gun or ammunition in the home. LPA's observed the Gun to be stored in a locked safe. The Gun and ammunition are stored separately. Applicant stated she does hold a foster family license. Applicant is current with immunization required per SB 792. The Applicant completed the Orientation on 09/14/2023. Applicant Pediatric First Aid/CPR certificate is valid until 08/26/25. Applicant took the Preventative Health on 9/14/2023. Applicant’s Mandated Reporter Training certificate is valid until 09/28/2025. Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216798
	VISIT DATE: 01/04/2024

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The applicant provided proof of control of property and was reviewed.

Applicant, 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, 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.

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) or (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.

LPAs reviewed with applicant, 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.
LPA discussed the safe sleep regulations with Applicant and discussed the Child Care

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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216798
	VISIT DATE: 01/04/2024

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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 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.

On this date, 01/04/2024, 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.

Applicant was informed of the MyChildCarePlan.org site, 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. Community Care Licensing Division (CCLD) regularly sends information to licensed.

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 platforms.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216798
	VISIT DATE: 01/04/2024

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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at: htttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The issuance of Small Family Child Care License is pending and is subject for further review and purchase of the following:

- Age appropriate tables and chairs

- Age appropriate toys for indoors and outdoor activities, and equipment

- Age appropriate books and coloring books.

-A locked will be install on a gate in the back yard. This lock will be placed on the inside of the fence.

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

Exit interview conducted and report was reviewed with the applicant,, Margarita Martinez on 01/04/2023.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC809 (FAS) - (06/04)

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