Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543802879
Report Date: 09/24/2018
Date Signed: 12/03/2018 07:13:16 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MARTINEZ DAY CAREFACILITY NUMBER:
543802879
ADMINISTRATOR:MARTINEZ, MIREYA & RAULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 535-2917
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY:14CENSUS: 4DATE:
09/24/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Mireya MartinezTIME COMPLETED:
09:30 AM
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(1)An unannounced annual/random inspection is made today. LPAs Brannon and Juarez met with licensee, Mireya Martinez. LPA Juarez provided Spanish translation during today's visit. A tour of the home, inside and outside; as shown on the facility sketch is provided. Staff and Children were spoken to during visit. There are no "bodies of water" or firearms in this home. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is no fireplace. There is a working fire extinguisher, a smoke detector, carbon monoxide detector and there is adequate heating and ventilation for safety and comfort. A clean and orderly home is observed. There are no pets observed today. There are no stairs in the home. Safe toys and play equipment are observed. There is a working telephone. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/FA are current. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Emergency information card containing information specified in regulation was verified for 4 children, who are presently enrolled. Hours of operation is Monday thru Friday, from 5:00 am to 5:00 pm, and arranged hours. Overnight care is not being provided at this time. Children have access to the day care room, one bedroom and the bathroom in the day care room.

LPA discussed new Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS)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 CONTINUED ON FOLLOWING PAGE
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2018
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MARTINEZ DAY CARE
FACILITY NUMBER: 543802879
VISIT DATE: 09/24/2018
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During the exit interview, licensee Mireya Martinez, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. LPA and licensee also discussed the Community Care Licensing Division's website, www.ccld.ca.gov. It is recommended that licensee's check the website often as the State of CA no longer mails updates to each licensee. LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) that allows licensee's to sign up and receive updates that are emailed directly. The website also has current information for providers including the Quarterly Update that inform licensee of new legislation and regulations. LPA provided SIDS brochure.

Per California Code of Regulations Title 22, Division 12, no deficiency was cited during today's visit. Exit interview conducted with licensee, Mireya Martinez.

A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.


THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2018
LIC809 (FAS) - (06/04)
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