434413088-1-28-2020-07-CC-SCOS-BL9KWN-20200128071609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413088
Report Date: 01/14/2020
Date Signed: 01/28/2020 07:16:15 AM

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, MICHELE		FACILITY NUMBER:	434413088
ADMINISTRATOR:	CHAIREZ-RAMIREZ, MICHELE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	4082349202
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 9	DATE:	01/14/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	Michelle Chairez Ramirez		TIME COMPLETED:	03:15 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 January 14, 2020 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee, Michele Chairez Ramirez explained the purpose of today's inspection. Upon LPA arrival, Assistant Mitchell Chairez was present in the home with 9 children in care . The Day-care is located in the back of home. Days and hours of operation are Monday through Friday from 07:00 AM – 5:30 PM. Licensee understands the capacity options and understands that the maximum capacity for a large family child care home is 14 children. There are (3) three adults residing in the home; Licensee, Licensee’s Husband (Timothy Ramirez), licensee’s, daughter Amanda and two children. A review of staff records on 01/13/2019 show that 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. Licensee and assistant has records showing proof of immunity against Measles and Pertussis. Licensee has proof of First Aid and CPR training Exp Feb 2020: Licensee and assistant have proof of current AB1207 Mandated Reporter Training Exp.( 07/2021) LPA reviewed the roster of children in care and a copy was obtained. LPA reviewed a sample of the children's files. Records reviewed include Parents' Rights, immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. The form LIC 282 "Affidavit Regarding Liability Insurance" were kept in the children's file.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CHAIREZ-RAMIREZ, MICHELE	FACILITY NUMBER: 434413088
	VISIT DATE: 01/14/2020

NARRATIVE

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LPA inspected the indoor and outdoor areas of the home. LPA observed a fully charged fire extinguisher, Smoke and Carbon monoxide detectors were tested and proved to be functioning. Last fire and disaster drills were last conducted and recorded on 12/2020. Off limit areas are as follows, The whole second floor, all three downstairs rooms, and Garage on the first floor. Off limit areas in back yard are along the sides of yard. The yard is completely fenced in and the home provides safe toys, play equipment and materials. There were no bodies of water observed.

Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. Licensee states that there are no weapons in the home.

Licensee stated she does not transport children. Licensee states that currently she is not providing Incidental Medical Services. 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.

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.

NO Regulatory violations were observed during the inspection visit. A copy of this report was given to Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

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