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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215849
Report Date: 02/01/2023
Date Signed: 02/01/2023 11:04:35 AM

Document Has Been Signed on 02/01/2023 11:04 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 FAMILY CHILD CARE AKA MRS. VITA'SFACILITY NUMBER:
566215849
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Vita K MartinezTIME COMPLETED:
11:20 AM
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On February 1st, 2023 at 9:40 AM, Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced Case Management- Licensee Initiated inspection to increase capacity. LPA met with licensee Vita Martinez and advised her of the reason for the inspection. Together with the licensee, LPA toured the home inside and outside. At the time of the inspection there were four (4) children in care along with two (2) cleared adults.

Licensee applied for a large family child care license. Family members residing in the home are two adults, licensee and licensee's husband.

All areas identified on the facility sketch were inspected. This is a single-story home which consists of three bedrooms, two restrooms, living room, kitchen, and dining room, detached garage and backyard. All areas of the home are accessible to children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons and hazardous items that can pose a danger to children. LPA observed outdoor play area to be safe and fully fenced. LPA observed age appropriate toys and structures outside and inside.

LPA observed a carbon monoxide detector to be located in the kitchen. Licensee has safety locks on kitchen cabinets, preventing children from accessing cleaning supplies and knives. A smoke detector was observed in the dining area. The regulatory fire extinguisher was observed to be located on the wall along with the receipt showing a purchase date of 1/23/2023.

A fire clearance was granted by the Ventura County Fire Department on 1/24/2023.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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 FAMILY CHILD CARE AKA MRS. VITA'S
FACILITY NUMBER: 566215849
VISIT DATE: 02/01/2023
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Licensee's and assistant's Pediatric First Aid/CPR certificate is valid through 5/22/2023. Licensee was reminded to renew her certification every two years. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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 (USDOJ) 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



Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect. LPA also provided a copy of Safe Sleep FAQ's along with a Safe Sleep Brochure, Individual Infant Sleeping Plan (LIC 9227), and a Safe Sleep Sleep Log Chart. LPA reminded licensee that 15-minute checks must be conducted for all sleeping infants up to age 2 and logged on the chart. LPA also reminded licensee that only infants up to 12-months of age need to be repositioned to sleep on their backs if Section C of the LIC 9227 has not been completed and they are observed in a different sleeping position.

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.

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SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
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 FAMILY CHILD CARE AKA MRS. VITA'S
FACILITY NUMBER: 566215849
VISIT DATE: 02/01/2023
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Entrance Checklist was provided to the licensee.

The home meets Title 22 Division 12 requirements of a Large FCCH. Effective date of license is today, February 1,2023.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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