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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215780
Report Date: 01/21/2020
Date Signed: 01/21/2020 04:25:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:RAMIREZ FCC AKA TINY TOTS CHILD CAREFACILITY NUMBER:
426215780
ADMINISTRATOR:ERICA RAMIREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 406-9471
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 13DATE:
01/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Erica RamirezTIME COMPLETED:
04:15 PM
NARRATIVE
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On January 21, 2020, at 3:45 PM Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management inspection as an follow up to an incident which occurred on October 24, 2019. LPA met with Erica Ramirez, Licensee of the Family Child Care Home (FCCH) and explained the nature of the inspection. LPA toured the interior and exterior of the FCCH. Thirteen children were on site at the time of the inspection.

Circumstances of the incident involved a child (Child #2) falling/being pushed from a play structure in the backyard of the FCCH and landed onto a concrete slab. Child #2 sustained a scratch on the forehead as a result of the aforementioned. The Licensee applied Ice to the injured area of Child #2 and notified the parent/guardian of Child #2. The Licensee did not contact or inform Community Care Licensing Division (CCLD) of the incident.

LPA discussed the reporting requirement as it related to unusual incident, specifically injuries to children in care. Licensee acknowledged CCLD should have been notified of Child #2 injuries.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D). The Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site visit) was posted during today's visit.

The LIC 9213 (Notice of Site visit) was posted during today's visit.
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LPA observed licensee post the Notice of Site visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RAMIREZ FCC AKA TINY TOTS CHILD CARE
FACILITY NUMBER: 426215780
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/28/2020
Section Cited

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Reporting Requirements-Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day...
This requirement is not met as evidenced by:
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Based LPA's interviews/observation/records review the Licensee failed to advise CCLD of the incident involving the injury of CHILD #1 via telephone after the occurrence and written report was received after 7 days of the occurrence.
This poses a potential risk to the health, safety and personal rights of persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 01/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2020
LIC809 (FAS) - (06/04)
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