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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019918
Report Date: 01/18/2023
Date Signed: 01/18/2023 01:34:55 PM

Document Has Been Signed on 01/18/2023 01:34 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:
198019918
ADMINISTRATOR:OLGA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 318-3482
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
01/18/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Olga Martinez TIME COMPLETED:
01:45 PM
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An announced case management inspection was conducted today by Licensing Program Analyst (LPA) Crystal Green to provide technical assistance with converting family home into a childcare center. Licensing staff met with Licensee Olga Martinez.

LPA was provided a tour of the facility’s indoor and outdoor areas. The facility is currently operating and a total of 14 children with 2 staff were present. During this inspection, LPA obtained measurements of the indoor rooms that will be converted into classrooms. LPA provided guidance regarding completing the application process to become a childcare center. No deficiencies were observed during this inspection.

Exit interview was conducted with the Licensee. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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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