444416383-9-23-2022-07-CC-CNEN-CJJUCA-20220923152738

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416383
Report Date: 09/23/2022
Date Signed: 09/23/2022 03:27:49 PM

Document Has Been Signed on 09/23/2022 03:27 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MARTINEZ, JESSICA		FACILITY NUMBER:	444416383
ADMINISTRATOR:	MARTINEZ, JESSICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 331-9289
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 9	DATE:	09/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Jessica Martinez		TIME COMPLETED:	03:37 PM

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 Analyst (LPA), Cortney Nelson, met with Licensee, Jessica Martinez, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee, conducted COVID risk assessment, and toured both indoors and outdoors during the inspection. Upon arrival, there were 9 children (7 preschool-age/ 2 infants), the Licensee, and 3 home residents present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 6:00AM-6:00PM and Licensee works with Migrant Head Start. Licensee states that adults, over the age of 18, residing in the home are: herself, her boyfriend (Angel), her sister (Daisy), her mother (Maria), her grandmother (Maria), and her father (Magdaleno). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). LPA advised that once Licensee's brother turns 18 that he should obtain fingerprint clearances and complete a tuberculosis test. Licensee 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. LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 8/15/2022, which is compliant with the six-month requirement for homes. LPA observed a fully charged 2A10BC fire extinguisher (last serviced: 1/2022), functioning smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Licensee states that there are no weapons or firearms in the home.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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

FACILITY NAME: MARTINEZ, JESSICA	FACILITY NUMBER: 444416383
	VISIT DATE: 09/23/2022

NARRATIVE

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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 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

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits inside the home include: four (4) bedrooms and the kitchen. There are no open-faced heaters in the home. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. There is a crib at the facility available for infants who may need it for napping. The crib follows all infant Safe Sleep regulations including a tight fitting sheet and nothing inside of the crib. Drinking water is readily available for children in the facility via water dispensers and plastic cups labeled with the children’s names. The bathroom in the home is clean, sanitary, and operable. LPA observed tooth brushes for the children that are safely maintained. The Licensee has a working telephone in the facility. Food (breakfast, lunch, AM/PM snack) is prepared and provided by the facility through Community Bridges food program.

The backyard area of the home was inspected. LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. There is a large foam area for infants to crawl while outside. Off-limit areas outside of home include: detached garage, storage rooms, and living quarters located beyond the fenced area for children. No outdoor bodies of water were observed during todays inspection. There is a functioning sink and diaper changing table located outside for children's use.

LPA discussed the 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 as an additional resource.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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

FACILITY NAME: MARTINEZ, JESSICA	FACILITY NUMBER: 444416383
	VISIT DATE: 09/23/2022

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8 children’s files were reviewed during todays inspection and all required documents were present, including sleep check documentation for all infants and Notification of Additional Child in Care (LIC9150). The Licensee maintains current liability insurance through DC Insurance Services, Inc that expires 1/15/2023. LPA advised Licensee to maintain paperwork for her children in ratio- updated Immunization Record and Identification and Emergency Information (LIC700) .

The Licensee and Home Resident files were reviewed and most required documents were present. LPA advised that any home residents that will be working with the children must maintain proof of immunization (tDap, MMR, flu). There is at least one staff member present with current CPR/First-Aid that expires 4/22/2023. The Licensee has current Mandated Reporter Training that expires on 5/11/2023 and LPA reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Jessica Martinez.

As a result of todays inspection, a deficiency was cited, see 809-D.

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.

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.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/23/2022 03:27 PM - It Cannot Be Edited

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, JESSICA	FACILITY NUMBER: 444416383
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above for her father who was assisting with the children today, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/07/2022
	Plan of Correction
1 2 3 4	The Licensee will submit proof of immunization for tDap, MMR, and flu for her father and any other home residents who may interact with the children while they are in care. Licensee will submit proof of immunizations to Licensing by 10/7/20222.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC809 (FAS) - (06/04)

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