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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012761
Report Date: 06/08/2023
Date Signed: 06/08/2023 03:40:47 PM

Document Has Been Signed on 06/08/2023 03:40 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RAMIREZ FAMILY CHILD CAREFACILITY NUMBER:
198012761
ADMINISTRATOR:RAMIREZ, MARIA REMEDIOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 575-1156
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Licensee Maria Ramirez TIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management inspection today, due to an incident that occurred on Thursday, May 25th, 2023. Due to COVID- 19 precautionary measures were taken, appropriate PPE was used. LPA met with Maria Ramirez, Licensee- census was taken.

Incident was reported on 6/1/2023- not within the required 24 hours. LPA advised that unusual incident reports have to reported within 24 hours a technical violation was given on this date. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received by email on 6/2/2023.

LPA Lopez observed the area where incident occurred and picture was taken. Based on information obtained during this inspection, no follow up is necessary regarding the incident reported.

At this time, the facility is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain 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 Licensee Maria Ramirez
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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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