434414740-5-9-2019-07-CC-JTSE-BBZQ2E-20190509114701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414740
Report Date: 05/09/2019
Date Signed: 05/09/2019 11:47:07 AM

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:	RAMIREZ, EDUVIGUEZ		FACILITY NUMBER:	434414740
ADMINISTRATOR:	RAMIREZ, EDUVIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 449-8576
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	14	CENSUS: 8	DATE:	05/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Alejandra Perez Ramirez		TIME COMPLETED:	11:55 AM

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	LPA Janet Tse met with licensee Eduviguez Ramirez's assistant, Alejandra Perez Ramirez for an annual/random inspection. LPA explained the nature of today’s visit to her. Licensee is not present in the home. LPA observed eight children including two infants with two assistants (AP & RR) in the home during today’s visit. Days and hours of operation are 24 hours, seven days a week. Licensee understands that no children can stay in the home for more than 24 hours at a time. The adults that reside in the home are Licensee, her husband, and her niece who is also her assistant. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 05/08/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately removes the individual and prevents them from returning to the home or having contact with children in care. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed stairs are barricaded from the bottom. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher and a working smoke and carbon monoxide detector. Licensee's assistant stated there are no weapons/firearms in the home. Off limit areas indoor: all three bedrooms and the garage. LPA observed a fenced backyard and no bodies of water. LPA observed a locked storage shed in the front yard. Off limit areas outside the home: fenced right side yard.. LPA observed the assistant (AP) has completed training on preventive health practices, and has current CPR Facility Evaluation Report dated 05/09/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

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: RAMIREZ, EDUVIGUEZ	FACILITY NUMBER: 434414740
	VISIT DATE: 05/09/2019

NARRATIVE

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Facility Evaluation Report dated 05/09/2019 to be continued from previous page:

and First Aid certification expiring 11/10/2020. The Assistant has completed the Mandated Reporter AB1207 Compliant Child Care Training on 11/29/2018; and a certification of completion is in file. LPA obtained a copy of the current roster of the children. LPA observed a fire and disaster drill log which is to be done at least once every six months. LPA reviewed eight children's files. Children’s immunization records are documented, maintained, and updated in form PM286. LPA observed Notification of Parents’ Rights is in each child’s file.

Supervision of children was discussed with the Assistant and she understands that Licensee must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee's Assistant understands the capacity options and understands that Licensee cannot have more than 14 children in the home at any time. LPA provided the Assistant with the ratio/capacity chart for reference. The Assistant stated that Licensee transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

A list of Family Child Care Home Licensing forms was provided and explained to the Assistant prior to the conclusion. Department website: http://ccld.ca.gov provided to the Assistant to download forms and to review Licensing regulations.

LPA also discussed "zero tolerance" related regulations with the Assistant and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation, and an ongoing civil penalty of $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to the Assistant and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Assistant understands the requirements.

LPA also discussed immunization requirement per AB 792 with the Assistant. LPA observed the required immunization records for Licensee and her assistants are in file. Incidental Medical Services were discussed with the Assistant. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC809 (FAS) - (06/04)

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