274415989-6-9-2021-07-CC-SCES-C3TSEQ-20210609134908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415989
Report Date: 06/09/2021
Date Signed: 06/09/2021 01:49:14 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 PEREZ, CARLOS		FACILITY NUMBER:	274415989
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	06/09/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Carlos Ramirez Perez		TIME COMPLETED:	02:00 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	On 06/09/2021, Licensing Program Analyst (LPA) Susy Cervantes, met with licensee, Carlos Ramirez Perez, for a case management visit for an increase of capacity. Licensee stated that on 6/3/2021, the City of Salinas Fire Department conducted their inspection and informed licensee that clearance was granted. Present was Licensee with no children. Days and hours of operation are Monday through Saturday, 12:00 am to 11:59 pm. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/09/2021 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period. LPA toured the inside and outside of the home. LPA observed a blocked fireplace, wall no heater, and no stairs. Off limits indoor: 2 bedrooms and attached garage. There are no bodies of water. Licensee stated there are no firearms/weapons in the home. LPA observed a 3A40BC fire extinguisher that is fully charged. Smoke detector and Carbon Monoxide detector are operable. LPA observed the fire department pull station in the kitchen. Telephone is in working order. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored in the garage. Backyard is fenced. There are no pets. Off limits outdoor: Left side yard, right side yard, and shed. The outdoor emergency exit is on the right side yard. *Continues on report dated 06/09/2021 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: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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: 06/09/2021

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Continuation of report dated 06/09/2021 pg. 2/2

LPA reviewed the ratio/capacity for a large family child care home with the licensee. Licensee stated that they do transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Licensee stated they have not been watching children for about 2 weeks, they are waiting for their increase in capacity to begin providing care Licensee has completed Mandated Reporter training on 8/14/2020. Licensee has Pediatric CPR/1^st Aid expiring 09/24/21. Licensee has all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza (decline statement) as well as TB testing. Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the immediate civil penalties for Zero Tolerance of $500. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was provided to the licensee. Department website: http://ccld.ca.gov provided to Licensee.

Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
An exit interview was conducted with Licensee in Spanish. LPA provided the report, appeal rights, and notice of site visit to licensee.
No deficiencies were cited during today’s inspection. Notice of site visit must remain posted for 30 days. LPA advised licensee that the request for an increase of capacity will be issued pending:
-Fire Department clearance
-Management Approval.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC809 (FAS) - (06/04)

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