073408422-11-18-2025-02-CC-CACA-DNK279-20251118160824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408422
Report Date: 11/18/2025
Date Signed: 11/18/2025 04:08:58 PM

Document Has Been Signed on 11/18/2025 04:08 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	RAMIREZ, LESLIE		FACILITY NUMBER:	073408422
ADMINISTRATOR/ DIRECTOR:	RAMIREZ, LESLIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 301-5536
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	11/18/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:45 AM
MET WITH:	Leslie Ramirez		TIME VISIT/ INSPECTION COMPLETED:	04:15 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	Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Annual Random inspection. Present during today’s inspection was the licensee, her fingerprint cleared husband and daughter and her adult son who does not have fingerprint clearance. There were 3 infants, 4 preschool aged children in care and licensee's preschool aged grandchild that lives in the home. The home was toured for Health and Safety Inspection. On limits area consist of the family room, dining room, first floor bedroom and first floor bathroom. The remainder of the home is off limits to children. Licensee is aware that the garage does not have fire clearance and is off limits to children. Off limits areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. The home has a swimming pool and hot tub. During the inspection LPA observed that the gate for the swimming pool was not self closing. During the inspection licensee called someone to the home to fix the gate. The gate is now self closing and latching. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. Stairs are gated. LPA verified that the fire extinguisher 3A40BC is fully charged. The home is equipped with a smoke detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. The fenced backyard is used for outdoor play. The licensee is operating within the licensed capacity.

NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Cherie Acosta
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

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 11

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
	VISIT DATE: 11/18/2025

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
26
27
28
29
30
31
32

Children’s files were reviewed. Licensee had files available for 3 out of the 8 children present during the inspection. One child present was the licensee's grandchild that lives in the home.
The licensee has current CPR and First Aid which expires 08/2026. Mandated reporter training was completed 10/29/24.
Licensee stated that fire and disaster drills are conducted at least once every six months. Licensee last documented drills conducted on 1/9/25.

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

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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for and removing any 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

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/.

NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Cherie Acosta
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 3 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
	VISIT DATE: 11/18/2025

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
26
27
28
29
30
31
32

LPA Cherie Acosta informed licensee that this report dated 11/18/25 document(s) 3 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Cherie Acosta informed the licensee to provide a copy of this licensing report dated 11/18/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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.

See 809-D for deficiencies cited today.

A notice of site visit was provided and must be posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Leslie Ramirez.

NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Cherie Acosta
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 4 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1597.543

Licensure Requirements

Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee did not have a carbon monoxide detector during the inspection which poses an immediate risk to the health and safety of children in care.
	POC Due Date: 11/19/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure the home has a working carbon monoxide detector. Licensee shall send proof of purchase to CCL by 11/19/25

Type A

Section Cited

CCR

102425(a)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee showed LPA mattresses that are placed on the floor for infants to sleep on. She stated that she places pillows between the mattresses when infants ate sleeping. This poses an immediate risk to the health and safety of children in care.
	POC Due Date: 11/19/2025
	Plan of Correction
1 2 3 4	During the inspection licensee set up play yards for the infants present. Licensee shall review safe sleep regulations and submit a self certified letter to CCL by 11/19/25 ensuring she understands the regulations and shall remain in compliance.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 5 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.814(a)(1)(A)(i)

Pool Safety

(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (A) An enclosure, including, but not limited to, a fence, wall, or other barrier that isolates the swimming pool from access to the family daycare home and has all of the following characteristics: (i) An access gate that opens away from the swimming pool and is self-closing with a self-latching, key lockable device placed no lower than 60 inches above the ground. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	During the inspection LPA observed that the gate for the swimming pool was not self closing and latching which poses an immediate risk to the health and safety of children in care..
	POC Due Date: 11/19/2025
	Plan of Correction
1 2 3 4	During the inspection licensee called someone to the home to fix the gate. The gate is now self closing and latching. The citation is cleared during the inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 6 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)1

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee is not currently documenting fire/ disaster drill which poses a potential risk to the health and safety of children in care
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall conduct and document fire/disaster drill and provide proof to CCL by 12/2/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 7 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.814(a)(3)

Pool Safety

(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee is not currently conducting daily inspections of the pool which poses a potential risk to the health and safety of children in care.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall conduct daily inspections of the swimming pool and maintain a log of the inspections. Licensee shall submit a copy of this log to CCL by 12/2/25

Type B

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee's adult son, Christopher Armijo, does not have criminal back ground clearance which poses a potential risk to the health and safety of children in care.
	POC Due Date: 11/19/2025
	Plan of Correction
1 2 3 4	Christopher Armijo was fingerprinted in October 2024 however the process was not completed. Christopher Armijo must be fingerprinted again and provided proof to CCL by 11/19/25

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 8 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee did not have proof of pertussis immunization which poses a potential risk to the health and sadfet of children in care.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall provide proof of pertussis immunization by 12/2/25.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee did not have immunization record for 4 of the children in care.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall have copies of immunizations for all children in care. Licensee shall submit proof of this to CCL by 12/22/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 9 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(b)

Child's Records

(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee did not have files for 4 of the children present during the inspection which poses a potential risk to the health and safety of children in care.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure she has complete files for all children in care. Licensee shall submit a self certified letter to CCL by 12/2/25 ensuring this is done.

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee does not have liability insurance. Licensee has not obtained a signed affidavit from parents stating that they have been informed that licensee does not have liability insurance.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall keep a signed affidavit in all children's files which states that parents have been informed that licensee does not have liability insurance. Licensee shall submit proof to CCL by 12/2/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 10 of 11

Document Has Been Signed on 11/18/2025 04:08 PM - It Cannot Be Edited

Created By: Cherie Acosta On 11/18/2025 at 02:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAMIREZ, LESLIE	FACILITY NUMBER: 073408422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee does not have individual sleeping plan for infants in care under 12 months of age which poses a potential risk to the health and safety of children in care.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure all infants under 12 months have an individual sleeping plan. Licensee shall submit proof to CCL by 12/2/25.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee is not currently documenting 15 minutes check of sleeping infants which is a potential risk to the health and safety of children in care.
	POC Due Date: 12/02/2025
	Plan of Correction
1 2 3 4	Licensee shall document 15 minute checks of sleeping infants and submit proof to CCL by 12/2/25

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:

	Cherie Acosta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025

LIC809 (FAS) - (06/04)

Page: 11 of 11