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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406816
Report Date: 07/03/2023
Date Signed: 07/03/2023 03:01:35 PM


Document Has Been Signed on 07/03/2023 03:01 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:JIMENEZ, LINDANFACILITY NUMBER:
073406816
ADMINISTRATOR:JIMENEZ, LINDANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 828-3784
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:14CENSUS: 1DATE:
07/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Lindan JimenezTIME COMPLETED:
03:00 PM
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On 7/03/2023 at 12:54pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Lindan Jimenez for a Required – 1 Year Inspection. Present during the inspection was the Licensee, her sister, K. Jimenez, husband, R. Garcia Lobaton, her brother, who was just visiting, and one (1) preschool age child. Licensee’s live in the home with her eighteen (18) year old daughter, her adult son, and husband. The facility operates from 7:00am – 5:30pm, Monday - Friday.

ON LIMITS AREA: Family Room, Downstairs Bedroom, Downstairs Bathroom and Front portion of Backyard
OFF LIMITS AREA: Entire 2nd Floor, Living Room, Kitchen, Dining Area, Downstairs Laundry Room, Garage and Both Sides of the Backyard
ISOLATION AREA: Downstairs Bedroom

The facility is a two-story home rented by the Licensee. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and there is one (1) small dog in the home.

The home has one (1) fully charged 2A10BC fire extinguisher in the family room on the counter. There is one (1) working smoke detector in the family room, outside of the downstairs bedroom and inside the downstairs bedroom. There is one (1) working carbon monoxide detector in the walkway between the downstairs bedroom and bathroom. The home is equipped with central heat and air for proper ventilation. Licensee uses play yards for the infant’s that are well maintained, and all other sleeping equipment and materials are clean, free from defects and properly stored.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JIMENEZ, LINDAN
FACILITY NUMBER: 073406816
VISIT DATE: 07/03/2023
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 Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. The fireplace in the family room is blocked by furniture and gates are used to make the staircase and the second floor inaccessible to the children in care. Licensee stated that she does not transport children.

The backyard is fully fenced with ample age-appropriate materials for the children in care. The left and right sides of the backyard have been made off-limits and is gated off. There is a jacuzzi in the gated off portion of the right side of the backyard. The jacuzzi is broken, empty, and has a cover with the appropriate locks. The jacuzzi is also enclosed inside of a gazebo like structure.

Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is completed and expires 4/23/2025. Licensee’s Mandated Reporter training is complete and expires 4/19/2024. A fire/disaster drill has not been conducted since 11/2022. LPA reminded Licensee that fire/disaster drills are to be completed every six months. All adults living and working in the home have obtained a criminal record clearance. All required forms are posted and visible for public view in the family room. LPA obtained a sample of the children’s files, the helpers file, the facility files, and facility roster. All files were complete. No deficiencies were cited during this inspection.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or email. Licensee was reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JIMENEZ, LINDAN
FACILITY NUMBER: 073406816
VISIT DATE: 07/03/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Lindan Jimenez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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 they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JIMENEZ, LINDAN
FACILITY NUMBER: 073406816
VISIT DATE: 07/03/2023
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Lindan Jimenez.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7