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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402205
Report Date: 02/19/2020
Date Signed: 02/19/2020 11:52:51 AM

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: 12DATE:
02/19/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rosalba RamirezTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced Plan of Correction site inspection for this facility at 1130. LPA met with licensee, Rosalba Ramirez, who was present along with 12 children in care consisting of two infants, six preschool age and four school age children including licensee's two school age grandchildren. Also present were licensee's adult son, David Ramirez, and adult daughter, Cristina Ramirez. All adults present are background cleared and associated to this facility. The facility is within ratio and capacity.

The prior deficiency cited 01/08/2020 was cleared during this inspection. There were no deficiencies cited today. A notice of site visit was issued and is to remain posted for 30 days. A copy of this report is to remain in the facility records for a period of three years.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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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