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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215549
Report Date: 01/28/2022
Date Signed: 01/28/2022 11:03:25 AM

Document Has Been Signed on 01/28/2022 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MARTINEZ FCC AKA ISSAC'S DAYCAREFACILITY NUMBER:
566215549
ADMINISTRATOR:MONICA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 307-4075
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Monica MartinezTIME COMPLETED:
11:15 AM
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On January 28, 2022 at 9:25 AM, Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced visit to conduct a Required - 1 Year Inspection. LPA met with licensee Monica Martinez and explained the purpose of the inspection. Prior to entering the facility, LPA conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA in the company of the Licensee toured the interior and exterior of the facility. Licensee and her assistant were caring for nine children at the time of the inspection.

The home is a four bedroom, four bath two story home. All adults in the home are fingerprint cleared. The licensee uses the back bedroom which has been converted into the main playroom, one bathroom, and backyard for day-care. LPA observed a child safety gate at the bottom of the stairs leading to the second floor making it inaccessible to children in care. The second floor is not used for day-care and is off limits to children. LPA observed a glass screened fireplace in the family room making it inaccessible to children in care. LPA observed age appropriate toys and furnishings available for children in care in good condition and free of hazards. Licensee has a secured fence in the backyard and age appropriate toys for children in care, found in good condition and free of hazards.
LPA observed a storage shed in the backyard made inaccessible with a key lock. LPA observed one small dog inside of the home. Licensee reported that the dog's vaccinations are up to date.

LPA observed the home to be orderly. No bodies of water were observed on site. No toxins nor hazards are accessible to children in care. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary. LPA observed a carbon monoxide and smoke alarm detector which were tested and found to be operable. A regulation 2A10BC fire extinguisher was observed in the kitchen with a service date of 01/11/2022. Licensee is reminded to service or purchase the fire extinguisher yearly.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTINEZ FCC AKA ISSAC'S DAYCARE
FACILITY NUMBER: 566215549
VISIT DATE: 01/28/2022
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LPA verified that the licensee and assistant are current with SB 792 immunization requirements. Licensee has a valid CPR/First Aid certificate with an expiration date of 06/16/2022. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 09/21/2023. The last fire drill was conducted on 12/12/2021. All required forms including Notification Of Parent's Rights are prominently posted for parent's or authorized representatives to view. A roster of children in care was observed current and complete. A sampling of children records were reviewed and LPA observed Identification and Emergency Notification forms (LIC 700) and a copy of immunization records on file.

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/inspection-process.

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 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. LPA also informed licensee 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.

No deficiencies cited during this visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Monica Martinez.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
LIC809 (FAS) - (06/04)
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