<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423006
Report Date: 10/04/2022
Date Signed: 10/04/2022 12:05:28 PM

Document Has Been Signed on 10/04/2022 12:05 PM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PENA RAMIREZ, JOSEFACILITY NUMBER:
013423006
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
10/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jose Pena RamirezTIME COMPLETED:
01:15 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 Oct 4, 2022 Licensing Program Analyst (LPA) Cortez conducted a case management visit for a capacity increase inspection. Present in the home today was the licensee Jose Pena Ramirez, and fingerprint and TB cleared wife Carolina Ramirez, and 3 children in care (pre school age). All requested documents were received for the increase of capacity application. The fire clearance for a capacity of 14 was received from the Hayward Fire Department


Ratios were discussed including proper ratio compliance in case an assistant is unavailable for a day and or does not come due to illness etc. The Licensee was reminded that whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. The home was toured and inspected for health and safety, all on-limints and off limits areas remain as licensed. The home is one story, which consists of 5 bedrooms, 4 bathrooms, kitchen, activity area(daycare), and backyard (Back yard/Outdoor play area) and garage. On Limit areas are: (1) bedroom (the one on the back), 2 bathrooms, converted garage to activity area (right side) kitchen, and the backyard .


The off limit areas will be the 4 bedrooms, 2 baths, dining room, living room. Part of the backyard where the bbq is off limits. The isolation area will be the on limit 1 bedrooom room (the one on the back).
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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 1