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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010001
Report Date: 08/04/2021
Date Signed: 08/04/2021 11:49:33 AM

Document Has Been Signed on 08/04/2021 11:49 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LINO-MARTINEZ, MARGARET FCCHFACILITY NUMBER:
493010001
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Margaret (Victoria) Lino-MartinezTIME COMPLETED:
12:10 PM
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An announced pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) Amy Strother. Applicant Margaret (Victoria) Lino-Martinez (A1) is requesting a license for a capacity of eight children with services available Monday through Friday, 06:20am through 5:30pm, year round. Parents and children will enter the facility using the front door of the home. A1 stated they understand consecutive, 24-hour care is prohibited and that childcare must be provided in the "primary" residence of the applicant. There are currently two adults living in the home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. During the pre-licensing inspection, LPA provided technical assistance to A1 related to COVID-19 guidelines and self-assessment.

The residence is a three bedroom, two bathroom, one story home. The floor and yard plans have been verified. Children in care will have access to the living room, dining room, kitchen, one bathroom, one bedroom and the backyard which is completely fenced. The "off limits" areas include the garage, laundry room, two bedrooms, and one bathroom, and outdoor shed marked as off-limits on the facility sketch. These areas were observed to be made inaccessible by door knob slip covers, locks, and/or child gates. There is a trampoline located in the backyard. The applicant understands if the trampoline is used during day care hours, it must be used according to the manufacturer’s recommended usage and the applicant must always provide/ensure supervision to the child on the trampoline and to the remaining children in care. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property is on file. The home appears to be clean and orderly at this time, and A1 reported it will remain so during child care hours. There is a working telephone in the home. The sharp knives, cleaning supplies, medications, and other potential hazards are stored out of the reach of children.

Continued on LIC 809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LINO-MARTINEZ, MARGARET FCCH
FACILITY NUMBER: 493010001
VISIT DATE: 08/04/2021
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A1 stated that there are no firearms or other weapons or ammunition stored on the premises and none were observed during today's visit. Any poisons will be kept in the off limits shed with is made inaccessible with a padlock.

LPA observed the home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2-A 10: BC. A1 stated there is no pool, pond, hot tub, fountain, creek, or other body of water on the property. Incidental Medical Services (IMS) regulations were reviewed with A1. A1 stated they understand that, if IMS are provided, an updated Plan of Operation shall be submitted and on file with the Department. A1 was advised Parent's Rights poster and other required postings must remain posted throughout licensure, emergency drills must be conducted and documented at least once every six months. Children's records to be maintained were reviewed. A1 stated they understand the roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. A1 stated they will maintain current pediatric CPR and First Aid certification, as well as Mandated Reporter Training certification. A1 stated they shall be present in and reside in the home and shall ensure that children in care are supervised by a fingerprinted adult with current pediatric CPR and First Aid certification. A1 understands that children may only be transported safely by adults with a criminal record clearance and are never to be left unattended in a vehicle. A1 understands infants and children shall not be allowed to sleep in car carriers in the home. A1 stated they clearly understand the maximum number of children for whom care can be provided, the limitations on the number of infants (birth to age 2) that may be cared for, and when two of the children in care must be school aged. L1 stated they understand smoking is prohibited at all times in any area where child care is provided.
A1 stated they understand the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home and that forms and regulations may be obtained from the website: http://ccld.ca.gov/.

Megan's Law web site information was provided: http://www.meganslaw.ca.gov. The AAP Guide to Safe Sleep Practices and the Effects of Lead Exposure brochures were provided and reviewed with A1. A1 stated they understand that any authorized employee of the Department may enter and inspect the facility with or without advance notice. A1 stated they understand that any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

This facility meets licensing standards. The application for licensure is approved, and the license is effective today 08/04/2021.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
LIC809 (FAS) - (06/04)
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