274412316-9-19-2019-07-CC-FCJO-BG6QHQ-20190919121132

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274412316
Report Date: 09/19/2019
Date Signed: 09/19/2019 12:11:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	RAMIREZ, LINDSAY		FACILITY NUMBER:	274412316
ADMINISTRATOR:	RAMIREZ, LINDSAY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 385-3715
CITY:	KING CITY	STATE: CA	ZIP CODE:	93930
CAPACITY:	14	CENSUS: 7	DATE:	09/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lindsay Ramirez		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Lindsay Ramirez, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 7:30 AM to 4:15 PM. Licensee stated she is the only adult residing in the home with her minor child 16 years old. LPA observed there were 7 preschool age children in care today. Licensee's certification for CPR and First Aid Card is current and will expire on 09/14/20121. Licensee's father and helper was also present in the home. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster and it is complete. LPA randomly reviewed 6 children's files and notice they have immunization records although they are missing the form PM286 (immunization form). Licensee is aware to complete the forms PM286. Licensee has performed a fire drill during the last six months. Last fire drill was documented on 9/16/2019. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: The attached garage, 2 bedrooms and one bathroom. Off limits areas outside: The left side yard. The home has a back yard and it is fenced and used as playground. LPA observed the home has a fire place in the off limits living room and it is barricaded. LPA observed a fully charged 3A40BC fire extinguisher that was last serviced on 11/2018 and at least one working smoke detector. LPA observed the home has a working carbon monoxide detector. LPA observed there are no stairs in the home. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services with licensee. According with the SB792 licensee has proof of immunization for measles, pertussis and influenza (opt out). *************************Report dated 09/19/2019 continues on Page 2 ***************

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RAMIREZ, LINDSAY	FACILITY NUMBER: 274412316
	VISIT DATE: 09/19/2019

NARRATIVE

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Report dated 09/19/2019 continues from page 1.

A review of staff records on 09/19/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and ratio (age of the children) must be observed and a helper must be present. Licensee understands if a helper is not present her license is reduced to the capacity of a small license (capacity 8). The Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee.
LPA observed licensee has completed the required "mandated reporter" training on 08/27/2019 and advised her that her helpers and other adults in contact with children must complete the training as well. LPA referred the Licensee to the Department website: www.ccld.ca.gov and www.mandatedreporterca.com for additional information on the online training.
LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

No deficiencies have been cited during today's inspection. Licensee rights was printed and given to Licensee. Exit interview was conducted with licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

LIC809 (FAS) - (06/04)

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