435700356-7-27-2022-52-CC-CURE-CGQPRW-20220727113324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700356
Report Date: 07/27/2022
Date Signed: 07/27/2022 11:33:39 AM

Document Has Been Signed on 07/27/2022 11:33 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	DIAZ MARTINEZ, OLGA		FACILITY NUMBER:	435700356
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/27/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Olga Martinez Diaz		TIME COMPLETED:	11:45 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

On 07/27/2022 at 9:30am, Licensing Program Analyst (LPA) Christina Uribe met with applicant Olga Martinez Diaz for the purpose of conducting an announced pre-licensing inspection. The applicant's fingerprint cleared husband was present in the home during the second half of today's visit. The home was toured for a health and safety inspection. LPA utilized Language Link to facilitate communication with the applicant as her primary language is Spanish during the first half of the inspection.

On-Limit Areas: Living Room, bedroom #1, bedroom #2, bathroom #1, and backyard.

Off-Limit Areas: Garage, kitchen, bedroom #3 (primary bedroom), & bathroom #2 (primary bathroom).

The facility is a single story home consisting of 3 bedrooms, 2 bathrooms, kitchen, living room, backyard, and attached garage which are neat and clean with heating and ventilation for safety and comfort. The off-limits areas are made inaccessible by closed and/or locked doors, child locks, safety gates, and visual supervision.

Backyard: The outdoor play area is located in the applicant’s backyard and is fully fenced and in good condition with no hazardous materials accessible to children in care. There are no pools, hot tubs, or any other bodies of water present in the on-limit areas during today’s inspection.

There are ample age-appropriate toys that appear to be safe and in good condition. The home is equipped with a fully charged 3A40BC fire extinguisher, functional carbon monoxide detector, smoke detector, & telephone. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

FIREPLACE: There is a fireplace located in the on-limit living room that is barricaded to prevent accessibility to children in care.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DIAZ MARTINEZ, OLGA	FACILITY NUMBER: 435700356
	VISIT DATE: 07/27/2022

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

Per applicant, there are no firearms or pets in the home during today’s inspection. The applicant is in compliance with the immunization laws which pertain to all childcare providers. All required forms are posted and visible for public review. Applicant completed and received certificates for Mandated Reporter Training & Pediatric CPR/First-Aid Training and was reminded of their responsibility to renew each training every two years.

Records to be Maintained: LPA reviewed the Packet of Records to be Maintained with applicant and thoroughly discussed each page and section for clarification and consultation. Applicant understands their responsibility for maintaining personnel and children's records, keeping complete and separate records for each child, and making them available for review upon request to the Licensing Department. LPA reviewed Personal Rights, Parents' Rights, Reporting Requirements, & Inspection Authority with the applicant.

PROVIDING IMS: This facility plans on providing Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department.

LPA informed applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Baby bouncers & drop-down cribs are not allowed at the daycare facility. Roster of children & their records must be properly maintained & available for review at all times. A fire/disaster drill must be performed and recorded at least every 6 months. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to the Community Care Licensing. The licensee was provided information regarding the effects of Lead Exposure and testing requirements (Assembly Bill 2370).

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

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DIAZ MARTINEZ, OLGA	FACILITY NUMBER: 435700356
	VISIT DATE: 07/27/2022

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

LPA discussed the safe sleep regulations with applicant 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 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. Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

This home is recommended for Licensure on 07/27/2022. This report shall remain on file for 3 years. Exit interview was conducted with applicant, Olga Martinez Diaz.

Page 3 of 3 ***End of Report***.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3