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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700205
Report Date: 10/14/2019
Date Signed: 10/14/2019 03:59:06 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:JIMENEZ, KARINAFACILITY NUMBER:
075700205
ADMINISTRATOR:JIMENEZ, KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 248-3508
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:14CENSUS: 0DATE:
10/14/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:JIMENEZ, KARINATIME COMPLETED:
04:00 PM
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An Announced follow-up Pre licensing Inspection was conducted today by Licensing Program Analyst (LPA) LaKeisha Chew and Licensing Program Manager, Sherelle Johnson. Present during inspection was Applicants cousin, Beatriz Yrene Vigueras. LPA met with applicant Karina Jimenez to verify the corrections that were indicated during an initial Pre licensing Inspection on October 02, 2019. Applicant indicated operating hours will be as follow Monday- Friday 7:30 AM - 6:00 PM. The home was re-inspected to ensure the children's health and safety. Applicant states she reside in the home alone.

Discussed with Applicant is any adult living and/or frequenting visiting the home must have a fingerprint clearance before being in the presence of day care children. A written statement was received from applicant indicating her son (Jeancarlo Ruiz) does not reside in the home statement was provided during today's inspection . Also discussed was the floor heaters in the bathroom and first bedroom (nap-room) used by day care children. The heater gets hot to touch and applicant has put a cabinet over the heater to make it inaccessible to children in care. However, Applicant will purchase floor registers (covers).
Applicant will submit a written statement saying she has reinforced the security of the book shelve along with pictures to verify proof of correction.

Pictures will be submitted as proof of correction by Monday, October 21, 2019.

The home is being licensed effective 10/14/2019 based on applicant agreeing to submit all correction by 10/21/19. License will not be mailed out until all correction have been verified. An exit interview was conducted with Applicant Karina Jimenez.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha ChewTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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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