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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413088
Report Date: 06/26/2019
Date Signed: 06/26/2019 05:15:34 PM

COMPREHENSIVE INSPECTION
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:CHAIREZ-RAMIREZ, MICHELEFACILITY NUMBER:
434413088
ADMINISTRATOR:CHAIREZ-RAMIREZ, MICHELEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 234-9202
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 11DATE:
06/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michele ChairezTIME COMPLETED:
05:20 PM
NARRATIVE
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On June 26, 2019 Licensing Program Analysts (LPAs) Stephanie Collins and Marilou Monico conducted an annual random inspection of the home. LPAs met with Licensee, Michelle, and explained the purpose of today's inspection. Present in the home were Licensee's Assistant, Michelle Chairez ,her mother Gloria Chairez and Licensee’s two daughters.

There were 11 children present of whom 2 were infant age. Days and hours of operation are Monday through Friday from 07:00 AM – 5:30 PM. Licensee understands the capacity options.
There are (3) three adults residing in the home; Licensee, Licensee’s Husband Timothy Ramirez, licensee’s daughter, Amanda. Licensees two children ages 15 and 4 also reside in the home.

A review of staff records on June 25, 2019 shows that all Facility staff or other individuals who require caregiver background checks 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 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.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: CHAIREZ-RAMIREZ, MICHELE
FACILITY NUMBER: 434413088
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2019
Section Cited
HSC
1597.622(c)
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Employees or volunteers at family day care home; immunization requirements[...} The family day care home shall maintain documentation of the required immunization's or exemptions from immunization[...] in the person’s personnel record that is maintained by the family day care home
This requirement was not met
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Licensee agrees to submit proof of Immunization for
herself and her assistant Michelle Chairez by POC date,
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as evidence by: Licensee and her assistant are missing immunization in measles and pertussis.
This poses a potential risk to the health and safety of children in care.
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Type B
06/26/2019
Section Cited
HSC
1596.8662(b)(1)
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[...] a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs [...] shall complete renewal mandated reporter training every two years [...]

This requirement was not met
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Licensee agrees to submit proof of Mandated Reporter training for herself and her assistant Provider Michelle Chairez by POC date.
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as evidenced by: LPA'S observed that licensee and her assistant are missing Mandated Reporter Training.
This poses a potential risk to the health and safety of children 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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CHAIREZ-RAMIREZ, MICHELE
FACILITY NUMBER: 434413088
VISIT DATE: 06/26/2019
NARRATIVE
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LPAs inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPAs observed a fully charged 2A10BC fire extinguisher. The whole second floor, all three downstairs rooms, and the Garage on the first floor are Off Limits. LPAs observed a child safety gate installed at the base of the staircase to prevent children from accessing the stairs. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. LPAs reviewed the facility's roster and obtained a copy. Fire and disaster drills were last conducted and recorded on June 19, 2019. Licensee states that there are no weapons in the home. Licensee has one small sized pet dog that is accessible to the day care children. Per Licensee, the dog is current with vaccination. The backyard is fenced and is used for outdoor activities. There is a hot tub in the backyard with a cover that can withstand the weight of an adult and it is locked.

Licensee’s Pediatric CPR and First Aid expires on 03/2020. LPAs' observed that Licensee and her assistant do not have proof of immunity against Measles and Pertussis. Licensee and her assistant do not have AB1207 Mandated Reporter Training Certificate.

LPAs reviewed 12 children’s files at approximately 3:42 PM. Records reviewed include Parents' Rights, immunization, Identification and Emergency Information, and Consent for Emergency Medical Treatment, Family Child Care Home Notification of Parents' Rights, and Affidavit Regarding Liability Insurance.

Children (#1 ) through (12) are missing form LIC282 Affidavit Regarding Liability Insurance. Licensee stated she does not transport children .

Licensee states that currently she is not providing Incidental Medical Services. 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) 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. .

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CHAIREZ-RAMIREZ, MICHELE
FACILITY NUMBER: 434413088
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2019
Section Cited
CCR
102416.3(a)(6)
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Alterations to Existing Buildings or Grounds -Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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Licensee states she will submit a written plan by POC date to ensure that prior to using an off limit area for daycare, an approval from Licensing must be received.
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This requirement was not met as evidenced by: LPAs observed a daycare in the off limit room. This poses a potential risk to the health and safety to children in care.
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Type B
07/03/2019
Section Cited
CCR
102417(m)(3)
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OPERATION OF A FAMILY CHILD CARE HOME - Licensee shall maintain a file of affidavits signed by each parent with a child enrolled in the home. This requirement was not met as evidenced by: LPAs observed that all children are missing a signed Affidavit Regarding Liability Insurance form in their files. This poses a potential risk to health and safety to children in care.
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Licensee states she will submit completed and signed Affidavit Regarding Liability Insurance for all children in care by POC date.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: CHAIREZ-RAMIREZ, MICHELE
FACILITY NUMBER: 434413088
VISIT DATE: 06/26/2019
NARRATIVE
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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. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Regulatory violations were observed during the inspection visit. Therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licensee. A copy of this report was given to Licensee.



NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5