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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020846
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:09:19 PM

Document Has Been Signed on 02/28/2024 02:09 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: 10DATE:
02/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Christine MartinezTIME COMPLETED:
02:30 PM
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On 2/28/2024, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced Case Management visit to amend complaint reports from a prior visit of 2/23/2024. A Covid risk assessment was conducted. LPA met with Licensee, Christine Martinez and a census was taken of 10 children present with 3 adults.

Notice of site visit was given to the licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Christine Martinez.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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