444412754-12-23-2022-07-CC-EBEN-CMDQPJ-20221223112049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412754
Report Date: 12/22/2022
Date Signed: 12/23/2022 11:20:55 AM

Document Has Been Signed on 12/23/2022 11:20 AM - It Cannot Be Edited

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:	RAMOS, ELVIRA & SAIDA		FACILITY NUMBER:	444412754
ADMINISTRATOR:	RAMOS, ELVIRA & SAIDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 539-8260
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 5	DATE:	12/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Elvira & Saida Ramos		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA), Elizabeth Berumen met with Licensee's Elvira and Saida Ramos and conducted an unannounced Required - 1 Year Inspection. Also present in the home were 5 day-care children (3 pre schoolers and 2 school-age) and Licensee, Saida's 1 year old daughter. LPA toured the indoor and outdoor areas of the home. LPA observed all the required posted materials. Days and hours of operation for the facility are Monday – Saturday, 5:00 AM- 10:00 PM. There are no active waivers or exceptions for this facility. Licensee states that there are five adults residing in the home: Licensee's, Saida's spouse, and Elvira's two sons. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed and obtained copy of facility roster (LIC9040). Fire/disaster drill was conducted on December 2, 2022. LPA observed a fully charged 2A10BC fire extinguisher, barricaded fireplace and functioning smoke and carbon monoxide detectors. Licensee states that he does not have any children in care who require Incidental Medical Services and does not administer medication at this time. Licensee states that there are no weapons or firearms in the home. Incidental Medical Services (IMS) policy was discussed. 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 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 Continuation on next pages:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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: RAMOS, ELVIRA & SAIDA	FACILITY NUMBER: 444412754
	VISIT DATE: 12/22/2022

NARRATIVE

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LPA observed that the home is clean, orderly, and safe for the day care children. Off limit areas inside the home: three bedrooms and garage. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture such as tables, couch, chairs, and shelves are in good condition and safe for children. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (831) 539-8260.

The outdoor licensed areas of the home were inspected and observed to be fenced in. Off limit areas outside the home: locked storage shed. Licensee uses the enclosed area of the backyard; far end of yard is fenced and off limits to children. There were no bodies of water observed.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended he registers all infant devices with the CPSC to be notified of any recalls on his purchased equipment.

Five (5) children’s files were reviewed during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC 627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC 282), and Immunization Records.

Both Elvira and Saida's files were reviewed for the following records: Criminal Record Statement (LIC 508), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), immunization in measles, pertussis, and flu, and required training. Licensee has immunization in measles, pertussis, and flu. The Licensee (Elvira) has Mandated Reporter Training that expires on 01/12/23. Saidas' mandated reporter training expired on 03/11/21.
Licensee's CPR/First-Aid expires on 03/19/2024. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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: RAMOS, ELVIRA & SAIDA	FACILITY NUMBER: 444412754
	VISIT DATE: 12/22/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensee's, Saida and Elvira Ramos.

As a result of today's inspection, no deficiency cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC809 (FAS) - (06/04)

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