Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310430
Report Date: 03/27/2019
Date Signed: 03/27/2019 05:36:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MARTIR, CELIAFACILITY NUMBER:
304310430
ADMINISTRATOR:MARTIR, CELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 726-4272
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:14CENSUS: 7DATE:
03/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Celia MartirTIME COMPLETED:
05:35 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an unannounced annual random inspection to the above facility. LPA met with Celia Martir, Licensee who guided analyst on a tour of the facility. The licensee states that 1 adult and 2 children live in the home. The licensee states that she currently has 8 children enrolled. During this inspection, there was 7 children present. A current children’s roster was available. The licensee was observed to be operating within the license capacity limitations during this inspection. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.
All areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. This is a one-story home which consists of three bedrooms, two bathrooms, kitchen, dining room, living room (FIREPLACE; inaccessible, gated), playroom room, backyard (fenced), and front yard (not fenced). Per licensees, the children use the one bedroom (nap room), one bathroom, playroom, and back yard (fenced). Based on the facility sketched, off-limit areas to children and parents include: two bedrooms, one bathroom, kitchen, dining room, living room, and front yard (not fenced). The licensee provides food for children in care.
The following was observed and reviewed during this inspection:
PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger were observed to be inaccessible to children during this inspection. The licensee states that there is no poison in the home, but does understand that if any poison is purchased, it is required to be locked with a key or combination lock.
Smoke and carbon monoxide detectors were tested and is operable. The valve on the required 2A 10BC fire extinguisher indicates fully charged; however, it has not been serviced within a year. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MARTIR, CELIA
FACILITY NUMBER: 304310430
VISIT DATE: 03/27/2019
NARRATIVE
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. Licensees’ and Assistance’s Pediatric First Aid and CPR expires 06/23/20. There are first aid supplies available.

During this inspection, the home was observed to be clean and orderly. When there are children in care who are less than five years old, stairs are required to be fenced or barricaded. There are no stairs in the home. LPA observed age-appropriate toys and learning material for the children in care.

Outdoor play is conducted in the back yard (fenced) under direct supervision. This area was inspected for safety and age-appropriate toys and equipment.

The licensee states that she has a landline and has a cell phone to use.


Per licensee, she does carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on file. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.
Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all of the information specified by regulation.

H&S 1597.622: 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.
SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.
The licensee and assistance have completed all required immunization against influenza, pertussis, and measles.

H&S 1596.8662: Commencing January 1, 2018 all the licensed providers, applicants, directors and employees are required to complete training as specified on the mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/. Licensee has not taken the mandated reporter training. LPA advised Licensee and her assistance to take the training and submit the certificates of completion to the department.

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MARTIR, CELIA
FACILITY NUMBER: 304310430
VISIT DATE: 03/27/2019
NARRATIVE
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LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always require an infant to sleep on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall disclose each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

Based on the LPA’s observations and records review, the following deficiency is listed on the attached LIC 809D (deficiency page) is being cited in accordance with California Code of Regulations Title 22. The deficiency that is being cited need to be cleared to protect the children’s health & safety. The deficiency was a type “B” deficiency. Licensee was also given a Technical Violation and a Technical Assistance which is documented on a LIC 9102TV and LIC 9102TA.

The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Celia Martir, licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

END OF REPORT
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MARTIR, CELIA
FACILITY NUMBER: 304310430
VISIT DATE: 03/27/2019
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LPA issued a Confidential Names List (LIC 811) to the licensee which documents the staff and/or children’s files that were reviewed during this inspection.
The following items were also discussed with licensee during this inspection:
All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Licensee have not completed a disaster drill.
PETS: There are no pets on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
There was NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance include:
Absence of Supervision, the licensee understands that arrangements must be made for a substitute adult to care and supervise children when they are absent from the home; Accessible Bodies of Water; No bodies of waters on the premises; Accessible Firearms, Ammunition or Both; No firearms or weapons in the home; Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles. The facility does not transport children.
Infant Care: Licensee states that she does care for infants. LPA advised the licensee to sleep infants where she can directly supervise at all times. The licensee stated the following as a supervision plan for infants: Licensee states that infants sleep in the living room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS
Incidental Medical Services (IMS):
Incidental Medical Services (IMS) was discussed. 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 (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.
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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARTIR, CELIA
FACILITY NUMBER: 304310430
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2019
Section Cited
CCR
102417(g)1
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102417(g)1 The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
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Per Licensee, she will submit a copy of the purchase reciept to LPA by POC due date of 04/03/2019.
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The requirement is not met as evidence by Licensee has not service fire extinguisher within the last year. This poses a potential risk to the health and safety fo children in care.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2019
LIC809 (FAS) - (06/04)
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