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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100043
Report Date: 05/17/2023
Date Signed: 05/17/2023 12:09:34 PM

Document Has Been Signed on 05/17/2023 12:09 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MARTINS, JASON FAMILY CHILD CAREFACILITY NUMBER:
376100043
ADMINISTRATOR:JASON MARTINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 705-4160
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Jason MartinsTIME COMPLETED:
12:15 PM
NARRATIVE
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On 05/17/2023 at 9:55am, Licensing Program Analyst (LPA), Selina Siao and Investigators T. Smith and G. Sun conducted an unannounced case management inspection. Upon arrival, there were 12 children including 4 infants and no school age in care supervised by licensee and his wife /helper Luani Chagas. Appropriate ratio was observed during today's inspection.

Department representatives observed a day care infant who was awake and was on a bouncer (prohibited item) in the nap room. Licensee was informed during the inspection that a bouncer is a prohibited item for all licensed child care facility.

See LIC809D for Type B citation issue.


Notice of Site visit was posted during today's inspection and it must be remain posted for 30 days. Failure to keep it posted could result in civil penalty of $100. Provided appeal rights to licensee.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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
Document Has Been Signed on 05/17/2023 12:09 PM - It Cannot Be Edited


Created By: Selina Siao On 05/17/2023 at 11:33 AM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MARTINS, JASON FAMILY CHILD CARE
FACILITY NUMBER: 376100043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2023
Section Cited
CCR
102417(g)(10)

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Operation of a Family Child Care Home
A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c). This requirement is not met as evidence by:
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Licensee stated that he was not aware that a bouncer is not allow. He removed the bouncer to an off limit area during today's inspection. LPA provided a photo chart of the prohibited items to licensee today.
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During today's inspection, department representatives observed an awake infant sitting on a bouncer (prohibited item) in the napping room. This poses a potential health and safety risk to clients 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:Monica Cuddy
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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