<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215849
Report Date: 10/15/2024
Date Signed: 11/12/2024 10:43:37 AM

Document Has Been Signed on 11/12/2024 10:43 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MARTINEZ FAMILY CHILD CARE AKA MRS. VITA'SFACILITY NUMBER:
566215849
ADMINISTRATOR/
DIRECTOR:		VITA K. MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 890-4859
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
10/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Vita MartinezTIME VISIT/
INSPECTION COMPLETED:
11:15 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 10/15/24, at 8:45 am, Licensing Program Analyst (LPA) Shane Loftus conducted an unannounced Annual/Random Inspection of the facility. LPA met with Licensee, Vita Martinez, and explained the purpose of the inspection. LPA in the company of licensee, toured the interior and exterior of the Family Child Care Home (FCCH). The FCCH uses the family room, 2 guest bedrooms, one bathroom, kitchen, and the backyard for child care. The remainder of the house is off limits to children. Licensee and 6 children were present at the time of inspection.

The FCCH has a regulation 2A10 BC fire extinguisher that was purchase on 10/12/24. LPA reminded licensee the fire extinguisher needs to be either serviced or newly purchased annually. LPA tested the smoke and carbon monoxide detectors at 9:15 am and found to be operational. The bathroom used for child care is clean and orderly. Cleaning supplies are stored in a cupboard beneath the kitchen sink which is secured by a child safety lock. Medications are stored in a cupboard above the refrigerator out of the reach of children. Sharps are stored in a kitchen drawer secured by a child safety lock. The FCCH does not have a fireplace. The FCCH has ventilation for childcare services.

The outdoor area has plenty of shade for the children in care. The back yard is secured with a combination of concrete and wooden fencing, entry/exit points are secured. Toys and equipment observed in the FCCH are age appropriate. There are no bodies of water on the property. There are no firearms and ammunition on the property.

The FCCH has the appropriate documentation posted in the home. A sampling of the children's records was reviewed. At 9:45 am, LPA observed the children’s documents to be missing immunization records and 15-minute safe sleep log. The remainder of the children’s documents were found to be current.

Continued 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTINEZ FAMILY CHILD CARE AKA MRS. VITA'S
FACILITY NUMBER: 566215849
VISIT DATE: 10/15/2024
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
At 10:00 am, The licensee’s records were reviewed and found to be missing TB clearance and Mandated Reporter training; the remainder of the documents were found to be current including CPR/First Aid that expires 4/2/25. LPA reminded licensee that Mandated Reporter AB1207 must be updated every two years. LPA also notes that there is no log of disaster and fire drill. LPA reminded licensee that emergency drills are required every six months and need to be documented.

Licensee does not provide Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Continued 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTINEZ FAMILY CHILD CARE AKA MRS. VITA'S
FACILITY NUMBER: 566215849
VISIT DATE: 10/15/2024
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
During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Type B Deficiencies are being cited based on LPA records review pursuant to Title 22 of the CA Code of Regulations and HSC. Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Vita Martinez.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 11/12/2024 10:43 AM - It Cannot Be Edited


Created By: Shane Loftus On 10/29/2024 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MARTINEZ FAMILY CHILD CARE AKA MRS. VITA'S
FACILITY NUMBER: 566215849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in that licensee does not document 15-minute sleep checks which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
1
2
3
4
Licensee will submit via email a completed 15 minute sleep log for infant in care to CCLD (shane.loftus@dss.ca.gov) no later than 10/29/24.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that licensee does not have current Mandated Reporter training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
1
2
3
4
Licensee will submit via email completed Mandated Reporter training certificate (AB1207) to CCLD (shane.loftus@dss.ca.gov), no later than 10/29/24.
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:Maria Mueller
LICENSING EVALUATOR NAME:Shane Loftus
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 11/12/2024 10:43 AM - It Cannot Be Edited


Created By: Shane Loftus On 10/29/2024 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MARTINEZ FAMILY CHILD CARE AKA MRS. VITA'S
FACILITY NUMBER: 566215849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that licensee does not have verification of TB clearance, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
1
2
3
4
Licensee will submit via email, proof of TB clearance to CCLD (shane.loftus@dss.ca.gov), no later than 10/29/24.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that licensee did not have children's immunization records, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
1
2
3
4
Licensee will provide via email, proof of children's immunization records to CCLD (shane.loftus@dss.ca.gov), no later than 10/29/24.
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:Maria Mueller
LICENSING EVALUATOR NAME:Shane Loftus
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6