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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100043
Report Date: 10/18/2023
Date Signed: 10/18/2023 03:32:37 PM

Document Has Been Signed on 10/18/2023 03:32 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
SAN DIEGO N. CC RO, 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: 5CENSUS: 7DATE:
10/18/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Luani Martins /licensee's wife and Jason MartinsTIME COMPLETED:
03:40 PM
NARRATIVE
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On 10/18/2023 at 2:10pm, Licensing Program Analyst (LPA) Selina Siao conducted a case management inspection for the purpose of ensuring the facility is within compliance. Upon arrival, licensee's wife Luani Martins was at the facility supervising seven children including her own infant and her two year old daughter. Five of the day care children including two are infants were observed napping inside the playpens. Facility is operating out of ratio today as there are no school age kid.

The day care children were napping in the second bedroom which was previously identified as an off limit office area prior to being approved by the department.

Luani Martins does have an EMSA approved pediatric CPR and First Aid card and was alone supervising the children. Licensee arrived during the inspection at 2:46pm.

See LIC809D for citations issue today.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
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 3
Document Has Been Signed on 10/18/2023 03:32 PM - It Cannot Be Edited


Created By: Selina Siao On 10/18/2023 at 02:33 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
, 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: 10/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/19/2023
Section Cited
CCR
102416.5(e)

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Staffing Ratio and Capacity:
If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidence by:
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Licensee stated that in the future if he needs to go out then he will take one of his kid with him to ensure that the facility is within ratio. Licensee stated that he will submit a written a plan of correction to LPA no later than 10/19/2023.
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Luani Martins was at the facility with seven children including five day care children and two of her own children. There are seven children in care including three infants and no school age child. This poses a potential safety risk to children in care. This is a repeat violation. Civil penalty of $250 is being assess today.
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Type B
10/23/2023
Section Cited
CCR102416.3(a)(6)

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Alterations to Existing Buildings or Grounds: Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed ... Any change from an area of the family child care home previously identified as "off limits" area where care and supervision will be provided to children in care.
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Licensee stated that he did not know that he was supposed to report the changes to the licensing department and he stated that he made the changes of the room due to low enrollment. Licensee stated that
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This requirement is not met as evidence by: LPA observed the day care children napping in the previously identified as the office (off limit) room and licensee did not inform the department or obtain approval prior to the change. This poses a potential health and safety risk to children in care.
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he will submit an updated facility sketch to the department to reflect the changes and a written plan of correction statement to LPA no later than 10/23/2023.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/18/2023 03:32 PM - It Cannot Be Edited


Created By: Selina Siao On 10/18/2023 at 02:46 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
, 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: 10/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2023
Section Cited
HSC
1596.866(3)(b)

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Additional health and safety training; Condition of licensure: licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the EMSA pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility. This requirement is not met as evidence by:
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Licensee stated that his wife will enroll into an EMSA approved pediatric CPR and First Aid course. Proof of registration and a copy of the cards will be submitted to LPA no later than 11/14/2023.
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Licensee's wife Luani Martins does not have an EMSA approved pediatrict CPR and First aid card and was alone caring for the children. This poses a potential health and safety risk to children 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:Tashima Daniel
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023


LIC809 (FAS) - (06/04)
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