434413670-9-16-2019-07-CC-SCOS-BG482Z-20190916220842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413670
Report Date: 09/16/2019
Date Signed: 09/16/2019 10:08:50 PM

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:	LARA-RAMIREZ, ROSIE		FACILITY NUMBER:	434413670
ADMINISTRATOR:	LARA, ROSIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	4082097040
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 12	DATE:	09/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Rosie Lara-Ramiriez		TIME COMPLETED:	04:50 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 September 16, 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of Family Community Care Home of licensee ROSIE LARA-RAMIREZ, LPA met with Licensee and explained the purpose of today's inspection. Present in the home during today’s inspection was Assistant Inez Lara and Twelve children. Licensee was reminded of capacity and ratio concerning Large Family Group Home. Days and hours of operation are Monday through Friday from 7:00 AM –6:00 PM. There are three adults residing in the home: The Licensee, licensee’s mother (Inez Lara) and Licensee’s Husband (Brian-Ramirez) and their three children. A review of staff records on (09/11/2019) 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. Licensee's Pediatric CPR and First Aid expires on 06/2021. LPA observed both Licensee and assistant have proof of immunity against Tuberculosis, Measles and Pertussis. Licensee and assistant both have proof of AB1207 Mandated Reporter Training (Exp. 08/2020) assistant Inez’s Mandated Reporter Training expires June 2021. LPA reviewed the roster of children in care and a copy was obtained.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

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: LARA-RAMIREZ, ROSIE	FACILITY NUMBER: 434413670
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/27/2019 Section Cited	1 2 3 4 5 6 7	HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. [...] The day care center shall maintain documentation of the required immunizations. This requirement is not met as evidenced by
	8 9 10 11 12 13 14	LPA's review of staff records, Staff Inez Lara does not have documented evidence of immunization against Pertussis. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

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: LARA-RAMIREZ, ROSIE	FACILITY NUMBER: 434413670
	VISIT DATE: 09/16/2019

NARRATIVE

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LPA reviewed children's files; Notification of Parents' Rights forms (LIC 995A), Emergency Contact Information, and Consent for Emergency Medical Treatment form. Licensee states she transports children as needed and she is aware of The California Seat Belt Law.

LPA inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPA observed a fully charged ABC 3-A-40-BC fire extinguisher. Fire and disaster drills were last conducted and recorded on 08/20/19. LPA observed cleaning supplies, knives and medications were inaccessible to children. Fireplace barricaded, off limit areas of the home are as follows: Garage, entire upstairs and 3 downstairs bedrooms in the rear of the home. There are two front bedrooms available for infants napping. Home has one dog, per Licensee the dog has been vaccinated. LPA observed a fully fenced back yard and is used for outdoor activities. Off limit areas in the Back-yard are the latched storage bin and side of yard in the yare are the along the sides side No bodies of water were 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 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.

Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training is available at: https://www.mandatedreporterca.com/

Regulatory violations were observed during the inspection. Therefore, citations were issued. Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with Licensee.

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: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

LIC809 (FAS) - (06/04)

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