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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408422
Report Date: 11/09/2021
Date Signed: 11/09/2021 05:05:26 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2021 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20211019154032
FACILITY NAME:RAMIREZ, LESLIEFACILITY NUMBER:
073408422
ADMINISTRATOR:RAMIREZ, LESLIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 301-5536
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 8DATE:
11/09/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Leslie RamirezTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Licensee left daycare child unattended
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Cherie Acosta and Diana Campos conducted unannounced visit to investigate the above allegation.

During the inspection on 10/27/21 LPA Chew observed an infant in the nap room in a pack and play with a blanket. The door was closed and there were no adults supervising the infant. LPA Chew also observed a second infant in a rocker in the garage with the door closed and no adult supervision. During the inspection LPA Chew observed the facility to only have one pack and play available for sleeping infants.

Based on LPAs observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2021 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20211019154032

FACILITY NAME:RAMIREZ, LESLIEFACILITY NUMBER:
073408422
ADMINISTRATOR:RAMIREZ, LESLIEFACILITY TYPE:
810
ADDRESS:1680 MARIGOLD DRIVETELEPHONE:
(925) 301-5536
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 7DATE:
11/09/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Leslie RamirezTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Licensee is not using safe sleep practices for day care infants
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Cherie Acosta and Diana Campos conducted unannounced visit to investigate the above allegation.

During the inspection on 10/27/21 LPA Chew observed an infant in the nap room in a pack and play with a blanket. The door was closed and there were no adults supervising the infant. LPA Chew also observed a second infant in a rocker in the garage with the door closed and no adult supervision. During the inspection LPA Chew observed the facility to only have one pack and play available for sleeping infants.

Based on LPAs observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 02-CC-20211019154032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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, LESLIE
FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2021
Section Cited
CCR
102425(a)
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Infant Safe Sleep. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. This requirement was not met as evidenced by:
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Licensee now has two pack and plays for the two infants in care. The deficiency is cleared during today's inspection
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During the inspection on 10/27/21 licensee had two infants in care and only one pack and play which poses an immediate risk to the health and safety of 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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 02-CC-20211019154032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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, LESLIE
FACILITY NUMBER: 073408422
VISIT DATE: 11/09/2021
NARRATIVE
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he attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit Interview was conducted with Leslie Ramirez
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 02-CC-20211019154032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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, LESLIE
FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2021
Section Cited
CCR
102425(j)(5)(A)
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Infant Safe Sleep The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain
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Licensee shall review the safe sleep regulations. Licensee shall comply with safe sleep regulations effective immediately. Licensee shall submit a letter to CCL by 11/24/21 ensuring she has reviewed and understands the regulations.
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open at all times. The provider shall be able to visually observe the infant without moving the door. This requirement was not met as evidenced by: Infants were put down for naps in rooms with closed doors and no visual supervision. One infant was placed in a infant rocker to sleep in the garage.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 02-CC-20211019154032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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, LESLIE
FACILITY NUMBER: 073408422
VISIT DATE: 11/09/2021
NARRATIVE
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· The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit Interview was conducted with Leslie Ramirez
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 8