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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001285
Report Date: 01/17/2020
Date Signed: 01/17/2020 03:38:29 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) 859-5970
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
01/17/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Elena RamirezTIME COMPLETED:
04:00 PM
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2, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 11 napping children, licensee, Elena and two helpers present today. The purpose of the inspection was explained. Current residents are Elena, her husband, their adult son and adult daughter. The facility personnel summary report was reviewed with Elena and she said it's correct. No change in the daycare areas as previously licensed. 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 stairs leading to the upper level are barricaded from children accessing the off-limit areas. The home is equipped with a fully charged fire extinguisher, a combination smoke detector, and a carbon monoxide detector. The facility has one dog and kept in the off-limit areas. Sandbox located in the outdoor yard is covered to keep away from foreign materials. The licensee and helper have current CPR & 1st aid current which expires 5/2021. Required immunization for licensee and staff members are on file. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (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 informed licensee to have a written IMS on file. Children's files were reviewed and in order. Last emergency drill was conducted 12-19-2019.
SIDS information was provided during the inspection.

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: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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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