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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700205
Report Date: 02/22/2023
Date Signed: 02/22/2023 12:17:47 PM


Document Has Been Signed on 02/22/2023 12:17 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
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: 13DATE:
02/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Karina JimenezTIME COMPLETED:
12:25 PM
NARRATIVE
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On February 22, 2023 at 9:20am, Licensing Program Analyst (LPA) Julia Placencia conducted a case management inspection while at the facility for another reason. LPA met with licensee Karina Jimenez. Present today were helper Claudia Quiroz and 13 children.

LPA toured the facility and approved the master bedroom and second bedroom in hallway to be used as ON-LIMIT child care rooms. Per licensee, these additional two bedrooms will be used by napping infants in pack-n-plays.

Upon arrival, licensee was observed to be operating beyond the limits of her license as there were 13 children present (4 infants and 9 preschoolers). Licensee operates as a large family child care which may have a maximum of 12 to 14 children, however, the 13th and 14th child(ren) must be school age.

See 809D for deficiencies cited today. 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.

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 each child's file to be reviewed by licensing.

This report shall remain on file for 3 years. A Notice of Site visit was provided and must remain posted for 30 days.

Exit interview conducted with Karina Jimenez. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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Document Has Been Signed on 02/22/2023 12:17 PM - It Cannot Be Edited

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 STE 1102
OAKLAND, CA 94612


FACILITY NAME: JIMENEZ, KARINA
FACILITY NUMBER: 075700205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2023
Section Cited

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1597.465(a) Large family day care; number of children - A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met: (a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
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POC: LPA observed one child left during inspection putting the facility in ratio. **Additionally, licensee shall submit a detailed plan on how she will remain in ratio at all times. Submit plan to LPA by due date of 2/23/23.

LPA may return to ensure compliance.
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This requirement is not met as evidenced by:
Based on observation and interview, there were 4 infants and 9 preschool age children present during inspection, which poses an immediate health and safety risk to children in care.
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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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
LIC809 (FAS) - (06/04)
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