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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402205
Report Date: 01/08/2020
Date Signed: 01/08/2020 01:10:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:RAMIREZ, ROSALBAFACILITY NUMBER:
073402205
ADMINISTRATOR:RAMIREZ, ROSALBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 741-7848
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: 10DATE:
01/08/2020
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Rosalba RamirezTIME COMPLETED:
01:15 PM
NARRATIVE
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License Program Analysts (LPAs) Paul Petersen and Russ Haderer met with licensee Rosalba Ramiez for a random annual inspection on 1-8-2020 at 11:20am. At arrival, LPA's were met by licensee, Rosalba Ramirez, who was present along with 10 children in care consisting of three infants and seven preschoolers including licensee's three year old grandson. The facility was out of ratio. Licensee reported that her assistant, Isabel Gutierrez, was briefly away from the facility and returned to the facility within 10 minutes of LPA's arrival. Licensee's recently turned 18 year old grandson was also present at the residence. Licensee and assistant are background cleared and associated to this facility.

All areas on limits to children in care were inspected for a health and safety inspection. The on limits areas are the entire house except the garage and the laundry room. Off limits areas are made inaccessible by closed doors and visual supervision. There are child safety latches on kitchen cabinets. There are no hazardous items/toxins observed to be accessible to children in care. The home is clean and organized with heating and ventilation available for safety/comfort. There are age appropriate furnishings, play items and equipment (including infant sleeping equipment) which are free of observed broken/sharp pieces. Per licensee there are no firearms present or stored on the premises.

The back patio/play area is fully fenced and the lower patio area is on limits to children in care. The upper patio area and hillside area are off limits to children in care. There are no swings or high climbing equipment present. Outdoor play items are free of observed hazardous conditions. LPA observed gardening tool present on the upper hillside area of the outdoors and reminded licensee to remove all tools prior to children present in the area. There are no pools, hot tubs or other bodies of water accessible to children.

The facility has a working carbon monoxide detector, working fire alarm and fully charged 2A10BC fire extinguisher.
Continued on Page 2**************************************************************************************
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: RAMIREZ, ROSALBA
FACILITY NUMBER: 073402205
VISIT DATE: 01/08/2020
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed the facility and children's records including parents' rights forms and children's immunization records. Licensee and assistant have current CPR/First Aid certification which expires 12/2021. All required postings are present. The facility roster was made current while LPA was present. The disaster drill log is current.

LPA reviewed with licensee the current Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility.

The Safe Sleep Awareness Campaign PIN packet was provided and reviewed. Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov.

The attached Type B deficiency is cited during this inspection. A copy of the appeal rights was provided. A notice of site visit was provided and is to be posted for 30 days. A copy of this report is to remain in the facility records and available for review for a period of three years from today's date.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, ROSALBA
FACILITY NUMBER: 073402205
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2020
Section Cited

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102416.5(e) 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 facility was not in compliance with this requirement as evidenced by LPA's observation
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that at the time of LPA's arrival, licensee's assistant was briefly away from the facility while 10 children in care were present in various stages of napping posing a potential risk to the safety of children in care.
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per day until corrected.

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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: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3