434416170-7-1-2021-07-CC-JCRZ-C4HP77-20210701110327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416170
Report Date: 07/01/2021
Date Signed: 07/01/2021 11:03:46 AM

Document Has Been Signed on 07/01/2021 11:03 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MARTINEZ, CLAUDIA		FACILITY NUMBER:	434416170
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 2	DATE:	07/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Claudia Martinez		TIME COMPLETED:	11:20 AM

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	Licensing Program Analysts (LPAs) Janette Cruz and Mel Matos conducted an unannounced Required – 1 year annual inspection. LPAs were granted access to the home by the Licensee. LPAs also observed Licensee's two children (4 years and 6 years), the Licensee's mother-in-law, Celia Sanchez, were in the home during today's inspection. The Licensee states that she has not had any day care children enrolled in her day care since she was licensed (08/26/2019); thus, no day care children were present during today's inspection. Licensee states that she wishes to keep her license active even though she does not have any day care children enrolled at this time. LPAs observed the required postings, including the facility license, near the front entrance to the home. The home has a working telephone (408) 464-9409. Days and hours of operation are Monday - Friday from 7:00 AM to 5:00 PM. The Licensee, Licensee's spouse, Isidro Delgado, Licensee's mother-in-law, Celia Sanchez, and Licensee's father-in-law, Jorge Avilarincon also live in the home. The Licensee's CPR and First Aid expired on 06/22/2021. LPAs observed proof of enrollment for CPR and First Aid certification renewal scheduled for 07/03/2021. The Licensee has the required vaccinations (MMR, TDap and flu). No children's files were reviewed during today's inspection since there are no day care children enrolled. The Licensee states that a child will be isolated in a corner by the dining room area if needed to because of illness or communicable disease. Safe sleep updated: LPAs discussed the new “Safe Sleep” regulations with Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to her. REPORT CONTINUED ON FOLLOWING PAGE #2 - REPORT DATED 07/01/2021):

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARTINEZ, CLAUDIA	FACILITY NUMBER: 434416170
	VISIT DATE: 07/01/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/02/2021):
LPAs reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPAs toured the indoor and outdoor areas of the home during today's inspection. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. There are no stairs inside the home. LPAs observed that there is no fireplace units in the home. LPAs observed two wall heaters in the living room and hallway areas of the home that are currently not barricaded. LPAs advised Licensee that wall heater must be barricaded and Licensee must submit a photo verifying that both wall heaters have been barricaded. Off limit areas inside the home: two bedrooms, and attached garage. Off limit areas outside the home: locked storage and right side area of the backyard.

LPAs observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee has pets (2 dogs and 2 cats) in the home and the Licensee states that all pets are licensed/vaccinated. The Licensee states that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked in the attached garage & storage shed inaccessible to the day care children.

A review of staff records on 07/01/21 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
REPORT CONTINUED ON FOLLOWING PAGE #3 - REPORT DATED 07/01/2021):

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARTINEZ, CLAUDIA	FACILITY NUMBER: 434416170
	VISIT DATE: 07/01/2021

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 07/01/2021):
Supervision of children was discussed with Licensee and she understands that she must be present in the home during day care hours (minimum 80 % of the operating hours of the day care) and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time. The Licensee states that the she plans to transport day care children in the future if needed. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

No deficiencies issued during today's inspection.

LPAs conducted an exit interview with the Licensee and the Licensee agreed to have the following items submitted to LPA Cruz by Friday July 16, 2021:

1) Licensee's proof of current flu vaccination
2) Picture verifying that the wall heaters, located in the living room and hallway areas of the home, are barricaded.
3) Updated Emergency Disaster Plan for Family Child Care Home (LIC 610A).
4) Updated certificate of completion of the Mandated Reporter for Child Care Workers.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC809 (FAS) - (06/04)

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