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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001285
Report Date: 01/04/2022
Date Signed: 01/04/2022 12:11:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:RAMIREZ, ELENAFACILITY NUMBER:
384001285
ADMINISTRATOR:RAMIREZ, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 305-6493
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 10DATE:
01/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elena RamirezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst, LPA Yee conducted a required-1 year inspection today. The purpose of the inspection was explained. Licensee, Elena is not feeling well, resting at her other home. LPA spoke to her on the phone. Present at the facility are three staff members and 10 children. Current residents are Elena, her husband, their adult son, and their adult daughter. The facility personnel summary report was reviewed with Elena on the phone, she said it's correct. Day-care areas: front entry room, daycare #1, daycare #2, day dare #3, bathroom, and back yard. The entire upper level is off-limit. The off-limit areas are barricaded from children accessing the areas. The facility has a fully charged fire extinguisher, a smoke detector, and a carbon monoxide detector. Children roster and staff files were reviewed. The licensee and helper have current CPR & 1st aid until 2/2023. Required immunization for licensee and staff members are on file. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/ One staff does not have AB1207 on file. The licensee said she will have the staff take the training and will send the certificate to CCL. LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Forms and website: www.ccld.ca.gov. Title 22, Div 12, Chp 3

Office: (650) 266-8800
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
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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