274415989-3-10-2021-07-CC-SCES-BYYPBA-20210310101000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415989
Report Date: 03/08/2021
Date Signed: 03/10/2021 10:10:06 AM

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 PEREZ, CARLOS		FACILITY NUMBER:	274415989
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	03/08/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Carlos Ramirez Perez		TIME COMPLETED:	11:00 AM

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	LPA Susy Cervantes contacted with applicant, Carlos Ramirez Perez and conducted a pre-licensing tele-visit for change of location.Tele-visit was conducted due to Covid-19. Applicant's current license is #274415962 which is located at 328 West Alisal, Salinas, CA 93901. Applicant stated that they are the only adult currently living in this home with no children. Applicant rents the house. Applicant plans on getting liability insurance and understood that if they decide not to carry liability insurance, they will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282). A review of staff records on 03/05/2021 indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded applicant 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. The home was inspected inside and outside. The home had a working smoke detector, a working carbon monoxide detector, a working telephone and a fully charge 3A40BC fire extinguisher. CPR and First Aid expire 09/24/21. Health, safety and nutrition training was complete on 09/17/19, lead training was completed on 09/04/20. Mandated Reporter training was completed on 08/14/20. Immunization's for Measles, Pertussis and Influenza are on file. LPA observed a covered fireplace and no stairs. Applicant stated that there were no pets, no firearms or weapons in the home. Off limit areas inside the home: Master bedroom, master bathroom, and the garage. LPA observed no bodies of water. The backyard is fenced. Days and hours of operation will be Monday through Sunday from 12:00 am to 11:59 pm. *Continues on report dated 03/08/2021, pg. 1/2*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2021

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 PEREZ, CARLOS	FACILITY NUMBER: 274415989
	VISIT DATE: 03/08/2021

NARRATIVE

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Continuation of report dated 03/08/2021, pg. 2/2
Cleaning products, hazardous and sharp objects were inaccessible to children and stored on the top kitchen cabinet and the off limits garage, Discipline policy was discussed with applicant and they understood that the children's personal rights should not be violated and corporal punishment is not allowed. Applicant stated that their discipline method will be speaking to the children and their parents. Applicant will transport children and understood the safety seat belt/car seat requirements.

A Family Child Care Home packet was reviewed with applicant. Department's website: www.ccld.ca.gov to obtain forms and regulations CCR, Title 22 was also provided. Applicant was advised on the regulations that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. Isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practiced at least twice a year and documented was discussed.

Incident Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 415-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the requirements of AB 633 with the Applicant and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPA also discussed "zero tolerance" related regulations with the Applicant and advised of the assessment of an immediate $500 civil penalty, and an ongoing $100 per day per violation continues until the violation(s) is corrected.

LPA conducted an exit interview with the Applicant in Spanish. LPA informed applicant that the report will be emailed to them. Applicant understands that in lieu of a signature, a read receipt or confirmation of receiving the report email must be submitted within 24 hours.
LPA advised applicant that Licensure for a small family child care home is granted pending the following:
- Management's approval.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2021

LIC809 (FAS) - (06/04)

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