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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274409429
Report Date: 08/20/2021
Date Signed: 08/20/2021 11:59:57 AM

Document Has Been Signed on 08/20/2021 11:59 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, JANETFACILITY NUMBER:
274409429
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Janet RamosTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with Janet Ramos, licensee, for an unannounced annual required inspection. LPA explained the nature of today’s inspection to her. Present was licensee's helper Lorena. LPA Days and hours of operation are Monday to Saturday, 8:00am to 6:00pm. The adults that reside in the home are licensee, her husband Richard, and her mother Maria. Licensee children ages 9, 7, and 4 years old. LPA observed there were 5 children present included 2 infants and 3 pre-school age.

A review of staff records on 8/13/2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevents them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed a barricaded fireplace in the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. LPA observed a fully charged 3A40BC fire extinguisher. LPA observed a working smoke detector and a working carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: master bedroom and attached garage. LPA observed there are no bodies of water in the home. Licensee's home has an empty off-ground pool in the off limits part of the back yard, LPA observed that part of the back yard is fenced and locked. Licensee stated she will get rid of the off-ground pool. Off limits outdoor: Right and left side yards and far back of the backyard. LPA observed one pet dog in the home. Licensee states dog stay in fenced off area or in the garage and is vaccinated.

Report dated 8/20/21 continues in page 2.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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, JANET
FACILITY NUMBER: 274409429
VISIT DATE: 08/20/2021
NARRATIVE
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Report dated 8/20/21 continues from page 1.

LPA observed licensee, her husband, her mother, and her helper have current CPR and First Aid certification that expiring on 1/18/22 and 6/16/23. LPA obtained a copy of the roster. Licensee documented the last fire drill on 6/14/21. LPA reviewed four children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. Licensee has not completed the Mandated Reporter training neither have her helpers.


Supervision of children was discussed with licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time, and ratio (age of the children) must be observed. LPA provided licensee with the ratio/capacity chart for her reference. Licensee stated she transports children via vehicle, licensee understands that children cannot be left in parked vehicles unattended at any time.

LPA discussed Zero Tolerance with $500 immediate civil penalty. LPA discussed the requirements of AB633 with the licensee. Incidental Medical Services were discussed with the licensee. The licensee is not providing Incidental Medical Services (IMS) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA referred the Licensee to the Department website: www.ccld.ca.gov and www.mandatedreporterca.com for additional information on the online training. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA advised licensee of the new regulations on Safe sleep for infant children. and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.
Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

One type B deficiency was cited.

Notice of site visit was issued and must be posted for 30 days.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/20/2021 11:59 AM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 08/20/2021 at 11:20 AM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RAMOS, JANET
FACILITY NUMBER: 274409429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2021
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training
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Licensee agreed to complete the mandated reporter training for herself and obtain the completion certificate from her helpers and all the adults in contact with the children in care. Licensee will submit copies of completion certificates to Licensing Department by October 5, 2021.
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every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by: Neither licensee or her helpers have completed the mandated reporter training. This poses a potential risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mary Segura
LICENSING EVALUATOR NAME:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2021


LIC809 (FAS) - (06/04)
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