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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020846
Report Date: 01/10/2024
Date Signed: 01/10/2024 01:31:24 PM

Document Has Been Signed on 01/10/2024 01:31 PM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
198020846
ADMINISTRATOR:MARTINEZ, CHRISTINE MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 251-3169
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 9DATE:
01/10/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Chrisitne MartinezTIME COMPLETED:
12:30 PM
NARRATIVE
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On January 10, 2024, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced annual inspection for the above facility. Covid risk assessment was conducted. LPA met with Licensee, Christine Martinez along with 2 adult assistants. LPA observed 9 children in care. A children’s facility roster was available. Per Licensee, operating hours are from Monday - Friday 8:30 am – 3:30 pm and cares for children ages 2 1/2 to 5 years of age. The licensee provides AM snack, lunch, PM snack to the children in care and licensee is not part of a food program.

This is a one-story home which consists of living room, family room/playroom, kitchen, additional kitchenette, dining room, front yard, back yard, side yard, 3 bedrooms and 3 bathrooms. The adults living in the home have been fingerprint cleared and licensee provided a LIC 279B for minors in the home. Areas used by the children are family room/playroom, side yard, back yard and 1 bathroom. Per Licensee, areas off limits to children and parents include 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, and front yard.

The licensee states that 2 additional adults besides herself and 3 children currently live in the home. Per Licensee, she has 2 adults who assist as they operate as a large facility. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed childcare home. 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.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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Document Has Been Signed on 01/10/2024 01:31 PM - It Cannot Be Edited


Created By: Carolyn Tuba On 01/10/2024 at 12:12 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020846

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record review, the licensee did not comply with the section cited above in there was no proof or expired mandated reporting certificate trainings for both assistants working at the child care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2024
Plan of Correction
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Per Licensee, both assistants will complete Mandated Reporting Training and will provide certificates to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024


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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020846
VISIT DATE: 01/10/2024
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The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service.
Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee conducted an Emergency Drill in August 2023. There is no one that smokes in the at family childcare home.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunization's (TDAP, MMR, TB and Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.



Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection and are kept under the kitchenette under the sink with a child proof lock.

LPA observed the required 2:A-10:B-C fire extinguisher and per Licensee it had been serviced on January 10, 2023 and was serviced but Fire Department did not update the service card. Per Licensee she will be calling the Fire Department to have it corrected and provide the LPA with proof. Per State Fire Marshall standards, fire extinguishers shall be service annually. The smoke detector and carbon monoxide detector were tested and operable. Per Licensee, there are no weapons, firearms, or bodies of water on the premises. According to Licensee there is one dog kept inside the home away from the children during operating hours.

LPA advised the Licensee with regards to safe sleep and that infants under 24 months shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name, date and initials of the person who checked on the child. Per Licensee she only accepts children 2 ½ years old. LPA will be sending Licensee a booklet on Safe Sleep. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. LPA advised Licensee the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020846
VISIT DATE: 01/10/2024
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee and assistant currently have Pediatric First Aid and CPR expires on 8/2025, which includes the EMSA sticker. There are first aid supplies available. Licensee currently have a mandated reporting training certificate AB 1207, which expires June 2024. The 2 assistants do not have proof of Mandated Reporting Certificates or have expired. LPA advised that Mandated Reporting training needs to be conducted every 2 years.

Currently, children are using the back yard and side yard for outdoor play time. The outdoor play area was observed to be enclosed with a concrete wall and meet the height requirements. LPA observed that the outdoor yard has toys, bikes, play structure, and other materials for children to play with.



Children and Staff records must be maintained and updated as needed and must be available for review by the Department. If Children and Staff leave the day care all records must be maintained for 3 years after leaving. LPA observed that Licensee and assistants have proof of immunizations (Tdap, MMR and TB) Licensee and Assistants have signed documentation declining Influenza.

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 [email protected]. 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.

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.


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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020846
VISIT DATE: 01/10/2024
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

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

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.

Please see LIC809-D pages for deficiencies cited during today's visit in accordance with the California Code of Regulations Title 22, Division 12, Chapter 1.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Christine Martinez.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
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